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Public Document No. 84 



FIRST ANNUAL REPORT 

OF THB 

TRUSTEES 

OF THE 

Boston State Hospital, 

For the Year ending Nov. 30, 1909. 




BOSTON: 

WRIGHT & POTTER PRINTING CO., STATE PRINTERS, 
18 Post Office Square. 
1910. 



Public Document 



No. 84 



1 ■'' 



FIRST ANNUAL REPORT 

OF THE y/ \M ^ 

9 

TRUSTEES 



Boston State Hospital. 



For the Year ending Nov. 30, 1909_ 1?/^ 




^ BOSTON: 
WEIGHT & POTTEE FEINTING CO., STATE PEINTEES, 
18 Post Office Square. 
1910. 

\ 



STATE H0U3S, BOSTG!^ 



Approved by 
The State Board of Publication. 



3 



CONTENTS. 



PAGE 

Report of Trustees, ........ 7 

Report of Superintendent, ....... 20 

Report of Superintendent of Nurses, ..... 30 

Report of Treasurer, ........ 33 

Statistics, .......... 43 



OFFICERS 

OF THE 

BOSTON STATE HOSPITAL. 



TRUSTEES 

Walter Channing, M.D., Chairman 
Henry Lefavour, Secretary, 
Mrs. Henrietta S. Lowell, 
Joseph Koshland, 
Mrs. Katherine G. Devine, 
William Taggard Piper, 
Michael J. Jordan, 



Brookline. 

Boston. 

Brookline. 

Boston. 

South Boston. 

Cambridge. 

Dorchester. 



Stated meetings of the trustees are held at the hospital on the second Tuesday 
of each month. 



OFFICERS. 



Owen Copp, M.D., 
William Notes, M.D., 
Samuel W. Crittenden, M.D. 
George H. Maxfield, M.D., 
Mary E. Gill, M.D., . 
Ermy C. Noble, M.D., 

Jane Robertson, 
Jessie M. Buist, 

Florence N. Spidle, . 
Arthur E. Morse, 
Louis S. White, 



Superintendent. 
Assistant Sxtperintendent. 
Assistant Physician. 
Assistant Physician. 
Assistant Physician. 
Assistant Physician. 
Assistant Physician. 
Superintendent of Nurses. 
Assistant Superintendent of 

Nurses. 
Matron. 
Chief Enyineer. 
Farmer. 



TREASURER AND STEWARD. 

William E. Elton, ...... Dorchester. 

Office at the Women's Department, Dorchester Center. 



VISITING COMMITTEES, 1909-10. 



February, ...... Mrs. Devine and Mrs. Lowell. 

March, ....... Mr. Lefavour and Mr. Koshland. 

April, ....... Mr. Jordan and Mr. Piper. 

May, ....... Dr. Channing and Mr. Koshland. 

June, ....... Mrs. Devine and Mrs. Lowell. 

July, ....... Dr. Channing and Mr. Piper. 

August, ....... Mr. Lefavour and Mrs. Lowell. 

September, . . . . • . . Mr. Koshland and Mr. Jordan. 

October, ...... Mrs. Devine and Mrs. Lowell. 

November, ...... Mr. Lefavour and Mr. Piper. 

December, ...... Mr. Koshland and Mr. Jordan. 

January, ...... Dr. Channing and Mrs. Devine. 



®t)e iHommontDealtl) of itlassacljusettB 



TRUSTEES' REPORT. 



To His Excellency the Governor and the Honorable Council. 

The trustees of the Boston State Hospital have the honor to 
present herewith their first annual report. 

Previous History of the Hospital. 
The Boston State Hospital, known until 1897 as the Boston 
Lunatic Hospital, was opened in 1839 in South Boston. In 
1884, 84 patients were transferred to Austin Farm in Roxbury, 
which was organized independently under the name of the Re- 
treat for the Insane. In 1889 the retreat was made a depart- 
ment of the hospital. In 1893 the first new building was 
occupied. In 1895 the new buildings were opened at Pierce 
Farm. In 1897 the name was changed to Boston Insane 
Hospital. In the beginning the departments were made inde- 
pendent units with separate superintendents. In 1898 these 
were consolidated under one superintendent, and the same year 
the names changed from Austin Farm to Department for 
Women, and from Pierce Farm to Department for Men. In 
1904 the Stedman, Walker and Butler buildings were opened. 

State Care of Boston's Insane. 
Pursuant to the Acts of 1908, chapter 613, all of Boston's 
insane came under the care of the State. Section 1 of the 
chapter above referred to reads as follows : " The commonwealth, 
after the first day of December in the year nineteen hundred and 
eight, shall, by the officers and boards authorized thereto, have the 
care, control and treatment of all insane persons who are now 
cared for by the city of Boston, or by any board of officers thereof, 



8 



BOSTON STATE HOSPITAL. 



[Dec. 



and the city of Boston shall not hereafter establish any asylum or 
other institution for the care of the insane, or after said date 
maintain any such institution, or be liable for the board, care, 
treatment or act of any insane person." Section 2 of the same 
chapter specifies in part that : " The institution or asylum in 
which such insane persons are cared for shall, after said date, be 
called the Boston State Hospital, and shall be subject to all laws, 
so far as they apply, governing state hospitals," and also that: 
" The government of said Boston State Hospital when estab- 
lished, shall be vested in a board of seven trustees." Section 3 
gives the State Board of Insanity authority, " with the approval 
of the governor and council, in the name and on behalf of the 
commonwealth, to take, or acquire by purchase or otherwise, the 
lands and buildings now constituting the Boston insane hospital 
in the city of Boston, together with any lands or buildings adja- 
cent thereto, which, in their opinion, may be necessary to ac- 
complish the purpose of this act." 

In accordance with section 2 of the act above quoted seven 
trustees were duly appointed by Governor Guild, as follows : — 

For the term expiring on the first Wednesday of February, 1916, 
Walter Channing* of Brookline. 

For the term expiring on the first Wednesday of February, 1915, 
Henry Lefavour of Boston. 

For the term expiring on the first Wednesday of February, 1914, 
Henrietta S. Lowell of Brookline. 

For the term expiring on the first Wednesday of February, 1913, 
Joseph Koshland of Boston. 

For the term expiring on the first Wednesday of February, 1912, 
Katherine G. Devine of Boston. 

For the term expiring on the first Wednesday of February, 1911, 
George H. Leonard of Boston. 

For the term expiring on the first Wednesday of February, 1910, 
Michael J. Jordan of Boston. 

First Meeting of the Trustees. 
A call was issued by the first-named of the above for the 
trustees to meet at the hospital on December 1, and all the 
members of the Board were present. Dr. Channing was elected 
c^hairman, and Mr. Lefavour secretary. It was voted that all 
officials occupying positions in the Boston Insane Hospital up 



1909.] 



PUBLIC DOCUMENT — No. 84. 



9 



to Dec. 1, 1908, be temporarily appointed to tlie same positions 
in the Boston State Hospital, and that the superintendent be 
appointed temporary treasurer. A committee, was appointed to 
prepare by-laws. 

The superintendent reported that the number of patients in the 
hospital December 1 was 7 48, — 306 of these being men and 442 
women ; number on visit, 115, — 34 men and 81 women. Total 
carried on the books, 863, — 340 men and 523 women. 

Prior to the meeting, the men's department, at which the 
meeting was held, was inspected by the Board. Since this time 
many inspections have been made of both the men's and women's 
departments of the hospital by the Board as a whole, by the 
visiting committees and by the individual members. 

The Condition of the Hospital. 

This hospital, unlike any other in the State, is, to all intents 
and purposes, two separate institutions. It will be remembered 
that the ordinary plan is to have an administration building with 
wings running out from it, one for each sex, making a very com- 
pact and easy set of buildings to administer. In the Boston 
State Hospital the men's department is about half a mile from 
the women's, and separated by broad fields and swamps, some of 
which, until recently, did not belong to the State. A much- 
travelled road also intervenes. 

As a consequence of this wide separation it is necessary to have 
two heating and lighting plants, requiring a much larger con- 
sumption of coal than in an ordinary institution of the same 
size. There are two halls, used both for religious services and 
amusements, duplicate offices for the superintendent and assist- 
ants, two kitchens, two carpenter shops, duplicate storerooms and 
refrigerators, duplicate stables for horses, and other duplicate 
arrangements. There is one bakery and one laundry, both out- 
grown and inadequate. 

The effort is made to carry on the two departments as a unit, 
but the great distance referred to, and the necessity of maintain- 
ing so many duplicate arrangements, materially increases the 
cost of maintenance. Many things which might be done in the 
way of treatment and care of the patients and the administration 
of details are very difficult. 



10 



BOSTON STATE HOSPITAL. [Dec. 



The trustees found that the buildings themselves presented 
quite a variety of conditions, as they v^ere erected at different 
times and after different plans. The first ones, of wood, are now 
used only for administration purposes and a nurses' home. The 
buildings erected in the 90's for the women's department are 
of stucco and wood. They are sightly in appearance, but, from 
the nature of the construction, somewhat out of repair. The 
same is true of the buildings in the men's department, erected 
at the same time ; though, on the whole, their condition is not 
quite as good as the other buildings. Owing to the economic 
conditions prevailing under a city government, the hospital was 
often unable to obtain sufficient appropriations for improve- 
ments and repairs desirable from year to year, and hence some 
of the things which, no doubt, the former trustees would have 
been glad to do had not been undertaken. 

The most recent buildings, called the Stedman, Walker and 
Butler, after the names of former superintendents, were opened 
in 1904. These are all thoroughly well-constructed, fire-proof 
buildings, and were found to require little in the way of repairs. 

Facilities for the administration of the hospital and the 
medical care of patients were not quite equal to those of the State- 
hospitals, though an effort has been made to meet some of these 
requirements. A room in the basement of one of the new build- 
ings, designed for a hydrotherapy department, had never been 
finished, so that it was impossible to do anything for the patients 
with that method of treatment. Another room had been partly 
finished for a laboratory, but never completed. In the men's 
department there were no arrangements for hydrotherapy, elec- 
tricity or laboratory work, and very little scientific work was 
being carried on in either department. 

It was found that the buildings erected in the 90's, while 
attractive externally, were in many ways very badly planned 
internally. Some of the wards were dark, poorly ventilated and 
unattractive. Much room was wasted in corridors. The living 
rooms in the buildings for the male patients were badly cut up by 
enormous chimneys in the center, taking away very materially 
from the space, and making it difficult for the attendants to look 
after their patients. 



1909.] PUBLIC DOCUMENT — No. 84. 



11 



Plans for the Development of the Hospital. 

After many careful examinations of the hospital, the trustees 
came to the conclusion that alterations in the buildings would 
be necessary, as well as a reorganization of the general and 
medical administration, to bring it up to the standard of other 
State hospitals. Even then, however, the difficulties of adminis- 
tration and the great expense attendant on so many duplications 
would not be overcome, and neither would the constantly increas- 
ing demand for accommodations be met. To unify, as far as 
possible, the management of the two departments, and to provide 
adequate provision for patients, it would be necessary to add 
more buildings. 

While a general policy for the development of the hospital was 
being considered, it became evident that to have it take tangible 
form some one should be appointed to take charge of the hospital 
who had had special experience and training as an administrator, 
and who would be able to work out definite plans, and, if possible, 
carry them forward to completion. In looking over the field for 
a man of the kind required, the attention of the Board was di- 
rected to Dr. Owen Copp, who had for ten years been the execu- 
tive officer of the State Board of Insanity. In conjunction with 
that Board, he had, during this long period, been gradually 
developing a broad scheme of hospital provision and organization 
for the entire State,. and largely to him was due the progress that 
had been made in the care of the insane. It was felt by the 
trustees that his great familiarity with the whole problem, and 
especially with the specific needs of the Boston State Hospital, 
would make him eminently fitted to assume charge of the hospital 
at this critical period in its history, and they therefore voted to 
ask him to become superintendent. 

Unfortunately, the State Board of Insanity did not feel that 
they could part with him, as the plans which they had in mind 
were not yet completed, and they were depending on his co-opera- 
tion to carry them out. They were willing, however, that he 
should temporarily devote half his time to the affairs of the hos- 
pital. While the trustees regretted that they could not have the 
whole of it, they felt that it was for the benefit of the hospital 
that they should take half. Accordingly, he was duly elected 



12 



BOSTON STATE HOSPITAL. 



[Dec. 



superintendent, and Dr. 'Nojes, who had acted in that capacity 
up to this time, was made assistant superintendent. 

Since the appointment of Dr. Copp much time has been spent 
in working out plans for the future development of the hospital. 
To accomplish the desired results the plans advocated by the 
State Board of Insanity seem the best ; that is, to make the 
Boston State Hospital into a large institution, to accommodate 
most of the insane from Boston and near-by towns, which might 
be called the metropolitan district. It will be remembered that 
the State Board recommended, for the carrying out of their 
plans, a hospital to care for acute cases in the city proper near 
the medical schools ; a custodial department which should be 
located on the site of the present hospital, the present buildings, 
of course, forming a part of this whole department; a sanita- 
rium for convalescents at some convenient point in the country, 
and a colony for incurable cases, also not far removed. 

According to the special report made to the Legislature by 
the State Board of Insanity, May, 1908, the so-called metro- 
politan district has a population of about 1,200,000, or 40 per 
cent, of the inhabitants of the State. It furnishes easily 1,300 
commitments, or 46 per cent, of all. About 4,800 belong to this 
district. Less than 15 per cent, of the insane resident in the 
metropolitan district can be cared for in the Boston Insane Hos- 
pital. Nearly three times as many are committed to the other 
State hospitals. " The claims of the metropolitan district," the 
report stated, now assume paramount importance and press for 
immediate attention. A metropolitan institution for at least 
2,000 patients should be established according to the general 
scheme outlined.'' 

As a matter of fact, the first steps have already been taken 
along these lines. Owing to the efforts of the State Board and 
others, the Legislature in June, 1909, appropriated $600,000 
for the purpose of erecting a hospital, for the observation and 
first care of acute cases of mental disease, in the city proper. In 
the act appropriating this money it was provided that this insti- 
tution should be under the management of the trustees of the 
Boston State Hospital. Further legislation also was enacted 
that the State Board of Insanity should be authorized to take, 
by eminent domain, such land as, in its opinion, might be neces- 



1909.] 



PUBLIC DOCUMENT — No. 84. 



13 



sarj to provide adequately for the necessary enlargement of the 
hospital, and such takings have been made of all the land not 
owned by the State, bounded by Austin, Harvard, Canterbury 
and Walkhill streets, so that a total area of over 232 acres is now 
the property of the Commonwealth. This large tract of land 
will provide for the expansion of the institution to the extent 
that will ultimately be required. 

The next step, and one which should be taken the coming year, 
in the opinion of the trustees, and which, it is hoped, will meet 
with the approval of the Legislature, is to add an infirmary 
group of buildings for both men and womeij, to accommodate 
300 patients, and the necessary officers and nurses, at a cost of 
$275,000. It will be seen that the erection of such buildings is 
in harmony with the general plan above outlined, but, further 
than that, it is of importance for the purpose of making the 
present hospital buildings of greater service, as a more thorough 
classification of patients can be made both as to mental condition 
and sex, and administration simplified. 

As a part of the plan for further buildings at the hospital, it is 
highly desirable that the facilities for both medical treatment 
and service should be materially improved upon. With this idea 
in view it is planned to erect an addition to the Butler, which 
will serve as a treatment building, with baths of various kinds, 
apparatus for electrical and other treatment, and rooms for 
patients requiring constant medical supervision ; also an exten- 
sive addition to the laundry, ultimately to be used only for 
laundry purposes, but which will for the present, while partially 
used as a laundry, provide shops for the carpenters and steam 
fitters, and industrial rooms for the patients. This is a much- 
needed addition, which it is hoped can be made the coming year. 
It may be stated here that the carpenter and paint shops are in 
the basements of the buildings occupied by patients, an arrange- 
ment which is regarded as hazardous, and does not exist in other 
State hospitals. These shops have been fireproofed for tempo- 
rary use. 

When the plans outlined above for the infirmary group have 
been carried out, the hospital will be in condition to care for 
several hundred more patients, and give them such medical 
treatment as they require. It will also be possible to do some 



14 



BOSTON STATE HOSPITAL. [Dec. 



scientific work in the institution itself. Of course, the center of 
the higher laboratory and research work will be at the hospital 
for the first treatment of acute cases in the city proper, but some 
such work can always be carried on with profit by the assist- 
ants in this department. 

The trustees and superintendent have spent much time, not 
only upon the plans for the proposed infirmary group, but also 
upon the further development of the institution along the lines 
recommended by the Board of Insanity, to provide for the care 
of the large number of patients, probably not less than 3,000, 
which in the future it may be expected the State will be called 
on to furnish accommodations for on the present hospital 
grounds. In conjunction with a landscape architect, the super- 
intendent has studied the contour of the entire property, and 
rough plans have been made for the grouping of different classes 
of patients at different points. Eventually, the present wooden 
buildings used for administration purposes and nurses' home, 
which are not only inadequate in many respects but dangerous 
on account of fire, and the stables and the cow barn, and other 
outbuildings which also are of wood, and unsanitary and out- 
grown, should be pulled down. 

Buildings will be required for the reception of acute cases as 
they come from the department in the city proper, and to some 
extent, no doubt, from other sources. Further provision for 
custodial cases will be necessary, as well as added infirmary 
buildings. There will be a considerable number of patients 
who can be usefully employed. These will be provided for 
together in industrial groups. On another part of the grounds, 
where the farm buildings are to be placed, will be located what 
may be called the farmstead group. Each one of these groups 
can be enlarged as rapidly as circumstances may demand. 

The lay of the land admirably adapts itself to a plan of this 
kind. The different groups can be entirely separate from each 
other, yet near enough to make administration comparatively 
easy. There is excellent land for garden and farming purposes, 
which will furnish occupation for a large number of patients. 

To carry out these plans will, of course, be the work of years, 
but the trustees feel that no group of buildings should be erected 
without considering its relation to the other groups which will 
be necessary in the future. 



1909.] 



PUBLIC DOCUMENT — No. 84. 



15 



Hospital for the First Care and Observation of Acute 

Cases. 

The trustees, having been authorized to buy land and erect a 
hospital for acute cases in the city proper, devoted much time to 
looking about for an available site. It was considered desirable 
to have this as near as possible to the medical schools, as it should 
be accessible not only to those engaged in teaching nervous and 
mental diseases but to students and others engaged in special 
research work. After a search of some months, and the consid- 
eration of many sites, the Board finally decided upon what is 
called the MacDonald lot, situated at the corner of the Parkway, 
Brookline Avenue, Fenwood Road and Vila Street, comprising 
about 90,000 square feet. After having been approved by the 
Governor and Council and the State Board of Insanity, this 
lot was purchased. 

Preliminary studies of the buildings will be undertaken as 
soon as possible. This work will be somewhat simplified from 
the fact that the Board of Insanity, a year ago, had made sketch 
plans for the same purpose, which, however, at the time, could 
not be utilized. 

Internal Administration. 

Attention has been paid to matters of internal administration. 
It seemed proper that the steward, Mr. William E. Elton, who 
had direct charge of the purchase and use of supplies and other 
business matters, should also act as treasurer, and he was accord- 
ingly appointed to that position. 

A finance committee was appointed under the by-laAvs, which 
has taken up many matters of business administration with the 
superintendent, and various modifications have been made. The 
system of accounting was changed from the one formerly used 
to that employed for the State institutions, which meant con- 
siderable hard work on the part of employees in the business 
office. It may be said here that the business affairs of the hos- 
pital were in excellent condition when the trustees took charge, 
purchases being made on a careful system. 

• In March there was a most unfortunate occurrence in the 
death of a violent paretic from internal injuries. On investiga- 
tion these were found to be partly due to maltreatment by two 



16 



BOSTON STATE HOSPITAL. [Dec. 



attendants. They were arrested, and after a vigorous prosecu- 
tion by the district attorney found guilty. One was sentenced 
to the house of correction for three years, and the other for a 
year and a half. 

The death of this patient led to an immediate investigation by 
the trustees of the medical care and treatment of patients. It 
was found that, owing to the amount of business and office work 
that the medical officers in the men's department were obliged 
to attend to, they had little time to make visits in the wards,, 
and often the number of attendants was too small to care for 
the patients. The trustees felt that more time should be spent 
in the wards in the men's department, and that there should be 
a more thorough supervision of the work of the attendants. 

On the recommendation of the superintendent, Dr. E. C. 
Noble was appointed as an additional assistant in the men's' 
department, and arrangements made to allow the physicians to 
devote more attention than heretofore to ward duties. In the 
women's department, where the number of assistants was larger, 
the patients were receiving careful medical attention, but the 
standard of nursing was not as good as it should be, and there 
were not enough nurses. 

Some time was spent in revising the schedule of salaries to 
harmonize with those in other State hospitals, with the idea that 
if the nurses were paid better wages it would be possible to get 
better ones, and to keep them for longer periods. Since this 
schedule went into effect there have been many more applications 
received, and the quality of the nursing staff has been gradually 
improving. Earnest efforts will be made in the future to pro- 
vide more amusements and occupations for the patients, and 
make the wards more cheerful and attractive by adding furni- 
ture, pictures, plants and other things suggestive of home sur- 
roundings. 

Diphtheria Epidemic. 
During the year there have been, from time to time, sporadic 
cases of diphtheria. In May and June the number of cases 
increased, and at the women's department developed into an 
epidemic. It was necessary to set aside a ward for the purpose 
of isolation, and Dr. Mary E. Gill was put in charge. Eor sev- 
eral months a large number of nurses and patients were sep- 



1909.] 



PUBLIC DOCUMENT — No. 84. 



17 



arated from tlie others. A few of the employees were sent to 
the south department of the city hospital. Dr. Southard, the 
pathologist employed by the State Board of Insanity to supervise 
the pathological work in all of the State insane hospitals, was 
requested to make a careful investigation of the epidemic. He, 
in conjunction with an assistant, is now conducting research 
work which it will take some months to complete, and which, it 
is hoped, will throw some light on the nature of such epidemics. 

A second epidemic, lasting, however, only a short time, oc- 
curred in October, most of the cases being in the men's depart- 
ment. An old farmhouse, called the Fottler house, which for 
some years had been used as a sleeping place for patients work- 
ing on the farm, was vacated and made into a contagious depart- 
ment, and several patients at once were sent to it. Fortunately, 
this second epidemic lasted only a few days, and up to the time 
of writing this report there has been no fresh outbreak. Much 
praise is due Dr. Gill, who for several months was isolated on the 
ward with the diphtheria patients. 

Rp:pairs and Improve:meists. 
One of the first things called to the attention of the trustees 
was the need of fire escapes upon one of the buildings in the 
men's and one in the women's department. As soon as possible 
these were provided, and in case of fire will make egress more 
easy than before. Painting has been carried on on a large scale, 
both on the inside and outside of many of the buildings, greatly 
to their improvement. Some of this work was done by the em- 
ployees of the hospital and some by contract. At the women's 
department there were many old board walks in a badly dilapi- 
dated condition. Some of these have been taken up and replaced 
by granolithic walks, which will make outdoor exercise in the 
winter months more comfortable for the patients. Some grano- 
lithic floors have also been laid in the men's department. A 
large amount of piping used for heating purposes has been re- 
moved, as it served no useful purpose. In this way a consider- 
able saving in fuel has been made. A new bath room has been 
put in in the nurses' home. An inexpensive solarium has been 
built by glassing in an open passageway between Stedman and 
Walker. A determined fight was made against gypsy moths and 



18 BOSTON STATE HOSPITAL. [Dec. 

other pests, which had done great damage to the trees. These are 
now in fairly good condition, but much work remains to be done 
the coming year. ]^ew furniture has been bought for some of 
the wards, which should be largely added to the coming year. 

Estimate of Expenses for 1910. 
The estimate of maintenance for the coming year has been 
placed at $213,550. This is an increase of $21,550 over the 
previous year. This is largely accounted for by the necessity 
of placing the nurses on a sixty-hour basis, in accordance with 
the plan pursued at some of the other State hospitals. To bring 
this about, 25 more nurses must be employed. Very little 
additional has been asked for for other purposes. One large 
item, for which too small an estimate was made last year, was 
the cost of water. As a city institution the hospital had re- 
ceived its water from the city without the cost appearing in 
the hospital accounts. When the State took over the institu- 
tion it at once began to pay to the city the usual water rates 
for large consumers, amounting in the year to $4,687, which 
makes an additional item of about $2,000 of expense over what 
was anticipated. A more detailed analysis of estimates will 
be found in the report of the superintendent. 



Summary of Appropriations. 

For maintenance, $213,550 00 

For an addition to the Butler building, for the treatment 

of acute cases, 39,000 00 

For the construction and equipment of three infirmary 
buildings, to accommodate 300 patients and the neces- 
sary officers and nurses, 275,000 00 

For the construction and equipment of an extension to 
the present laundry, to be used temporarily for car- 
penter and machine shops, and industrial rooms for 
patients, 44,000 00 



Death of a Member of the Board. 
Early in the year the trustees were saddened by the loss of Mr. 
George H. Leonard, who died on February 10. They held a 
special meeting and attended the funeral in a body. At the 
March meeting the following resolutions were adopted : — 



1909.] 



PUBLIC DOCUMENT — No. 84. 



19 



The trustees of the Boston State Hospital desire to place on record 
their sense of great loss in the death of their honored associate, Mr. 
George Henry Leonard. Although the Board had been in existence 
for only a short period, and the official reign of its members had been 
brief, the trustees had come to hold a high appreciation of Mr. 
Leonard's qualities and careful judgment, his loyal devotion to duty 
and his willingness to give generously of his time and thought, and 
they had anticipated with satisfaction his most valuable service in the 
solution of the problems and discharge of the duties imposed upon 
the Board. 

The trustees beg to extend to the family of Mr. Leonard their pro- 
found sympathy. 

The place of Mr. Leonard on the Board was filled by the 
appointment of Mr. William Taggard Piper of Cambridge 
for the unexpired term. 

Chais^ges in the Medical Staff. 

The appointment of Dr. Copp and Dr. Noble have been 
already referred to. At the October meeting of the Board a 
letter of resignation from Dr. F. X. Corr, assistant physician 
in the women's department, to take effect November 1, was read 
and accepted. At the November meeting a letter of resignation 
from Dr. William Noyes, to take effect January 1, was read 
and accepted. A resolution was adopted expressing the per- 
sonal esteem of the trustees for Dr. Noyes, and their apprecia- 
tion of his long years of faithful service to the hospital. 

The reports of the superintendent and treasurer are ap- 
pended. 

Respectfully submitted, 

WALTER CHANNING, 
HENRY LEFAVOUR, 
HENRIETTA S. LOWELL, 
JOSEPH KOSHLAND, 
KATHERINE G. DEVINE, 
WILLIAM TAGGARD PIPER, 
MICHAEL J. JORDAN, 

Trustees. 



20 



BOSTON STATE HOSPITAL. [Dec. 



SUPERINTENDENT'S REPORT. 



To the Trustees of the Boston State Hospital. 

The first annual report of the superintendent is respect- 
fully submitted for the year ending Nov. 30, 1909, except 
the general statistics prescribed by the State Board of Insanity 
for the year ending September 30. 

There were 814 patients in the hospital at the beginning 
of the statistical year, 449 were admitted, 341 were dismissed, 
and 132 died, leaving 790 at the close of the year. 

The daily average number of patients was 769.85, of whom 
671.62 were State charges and 98.23 private patients; 1,173 
different patients were in the hospital during the year. 

There were 73 emergency cases, of which 67 were committed 
and 6 discharged within the five days' limit. 

One voluntary patient was received who was not insane and 
did not require commitment. 

Exclusive of transfers and returns from visits, 335 patients 
were received, of whom 299 were admitted for the first time, 
25 for the second time, and 11 for the third to fifth time. 

The first cases of insanity numbered 274, of whom 39.78 
per cent, were born in Massachusetts and 51.09 per cent, in the 
United States; 12.04 per cent, of the mothers were born in 
Massachusetts and 21.53 per cent, in the United States; 9.85 
per cent, of the fathers were born in Massachusetts and 21.53 
per cent, in the United States. 

The average age on admission of cases first admitted to any 
hospital was 45.84 years; 22.62 per cent, were aged 60 years or 
more. 

The chief causes of insanity were senility in 18.25 per cent., 
intemperance in 9.49 per cent., apoplexy and other organic 
lesions in 10 per cent., congenital in 3.65 per cent. 

The duration of mental disease before admission to the 
hospital averaged 16.32 months. It was six months or less in 



1909.] 



PUBLIC DOCUMENT — No. 84. 



21 



47.44 per cent, corresponding closely with the average per- 
centage for the State. 

Manic-depressive insanity and other curable forms consti- 
tuted 33 per cent, of the first cases of insanity admitted ; demen- 
tia pra3cox, 10.5 per cent. ; alcoholic and organic dementias, 13 
per cent. ; senile dementia, 17.5 per cent. ; general paralysis, 
14 per cent.; paranoia, epilepsy and imbecility, 7.6 per cent. 
It thus appears that hardly more than one-third of the first 
cases of insanity had a chance of recovery at the time of ad- 
mission to the hospital. 

The discharges, exclusive of 90 transfers, numbered 184, of 
which 54 were recoveries, being 16.12 per cent, of commitments. 
In addition, 21 patients were discharged capable of self-sup- 
port. Together they totalled 75, being 22.40 per cent, of com- 
mitments, against a percentage of 22.46 for the State last year. 
This represents the proportion of the insane restored to self- 
support in the community. 

There were 132 deaths, 11.25 per cent, of the whole number of 
patients under treatment, against a five years' average percent- 
age of 9.01 for the six State hospitals. Death resulted from 
pulmonary tuberculosis in 11, or 8.33 per cent., comparing with 
a four years' average percentage of 8.85 in the six State hos- 
pitals; from general paralysis in 36, or 27.2 per cent, compar- 
ing with such four years' average percentage of 17.44; from 
senile insanity in 41, or 31.06 per cent., comparing with such 
four years' average percentage of 31.18; from coarse organic 
brain lesions in 17, or 12.88 per cent., comparing with such 
four years' average percentage of 11.54. Curable forms of 
mental disease affected 25, or 18.94 per cent., comparing with 
such four years' average percentage of 11.37. Death occurred 
within three months after admission in 46, or 34.84 per cent., 
comparing with last year's percentage of 29.39 for the six State 
hospitals. 

Diphtheria. 

The general health throughout the hospital has been good 
aside from an epidemic of diphtheria. 

Early in February a woman nurse contracted the disease 
while absent from the hospital on a visit to a sick friend, with- 



22 



BOSTON STATE HOSPITAL. 



[Dec. 



out knowing the nature of her illness. Within the next three 
months five nurses came down with the disease and were treated 
in the South department of the Boston City Hospital. 

Late in May it seemed wise to quarantine the hospital 
against the admission of new patients and the visits of friends, 
and to take cultures from every person in the women's depart- 
ment, in addition to the isolation of persons affected and 
thorough disinfection of rooms, bedding, clothing, etc., which 
had been done in every case. Those furnishing jDositive cul- 
tures were isolated in the two upper Stedman wards. Such 
systematic culturing and isolation were repeated twice at inter- 
vals of a few weeks. In all, 2,325 cultures were made, 160 
persons isolated, and released only after yielding three consecu- 
tive and negative cultures. There were clinical symptoms in 
only 25 cases, 18 nurses and employees and 7 patients, the other 
135 presenting no evidence of the disease other than the pres- 
ence of the bacilli diphtherise in the nose or throat. When the 
last case had been released, on August 24, each ward was 
vacated and thoroughly disinfected with formaldehyde. 'No 
new cases developed during August and September, but from 
October 1 to 5 there was a sharp incidence of 18 clinical cases, 
13 in the women's department and 5 in the men's department. 
No case, however, has since appeared. In both departments 
there were 31 clinical cases, 22 nurses and employees and 9 
patients. There were no deaths, but temporary paralysis pro- 
tracted the convalescence of two and serious affection of the in- 
ternal ear impaired the hearing of another. Twelve cases were 
treated in the Boston City Hospital. Dr. Gill courageously 
assumed treatment of the women patients isolated in the Sted- 
man wards, and deserves our grateful appreciation of her 
faithful service during three very trying months. We are 
also greatly indebted to Dr. Francis H. Slack and Dr. Burditt 
L. Arms, of the Boston board of health laboratory, for making 
the necessary bacteriological examinations from so many cul- 
tures. 

At the suggestion of Dr. E. E. Southard, pathologist to the 
State Board of Insanity, advantage has been taken of the 
excellent opportunity afforded for the investigation of certain 
aspects of the epidemiology of diphtheria which could best be 



1909.] 



PUBLIC DOCUMENT — No. 84. 



23 



worked out in an institution. Under his direction, Dr. Mary 
Elizabeth Morse has carried it on during the past six months, 
and will continue it to completion, probably within the next 
half year, when a full report will be made and published. 

The Teaining School for Nurses 
has been conducted along the usual lines. Diplomas were 
awarded at the completion of the two years' course to 8 grad- 
uates. Since its organization, ten years ago, 64 nurses have 
been graduated, of whom 20 are still in the service of the hos- 
pital. The whole corps of nurses and attendants numbers 102, 
of whom 65 are women and 37 men. In the women's depart- 
ment 20 are graduate nurses, 18 pupils or probationers in the 
school. The remaining 27 women attendants and all the men 
attendants have not received systematic instruction as to their 
duties or nursing; in other words, no adequate effort is being 
made to train about 63 per cent, of our nursing staff. While 
it has been found impracticable in this hospital, as in most 
other public institutions, to exclude all who may be unwilling 
to follow a prescribed course of study, extending over a period 
of two years, it would be desirable and reasonable to expect 
all during the continuance of their service to listen to the teach- 
ing and participate in ward demonstrations, with reference 
especially to the more practical aspects of their duties. Such 
a requirement would promote efficiency, stimulate interest and 
induce some to assume the obligations of the full training. 

The general nurse must supplement her experience in the 
insane hospital by that of general and special hospitals for 
other diseases. Some of our graduates have been able to ar- 
range for themselves such special courses, particularly in the 
New York polyclinic. Our interest in their development and 
success will command our earnest effort to facilitate such 
arrangements, and if possible establish a definite relation of 
our school to other hospitals for this purpose. 



24 BOSTON STATE HOSPITAL. [Dec. 



The Instability of Service 
so universal and regrettable in institutions for the insane affects 
this hospital to a notable degree. The nursing staff on the 
average rotated 2.75 times during the year, compared with 2.52 
times in the six State hospitals. This means an average ten- 
ure of 4.36 months, a handicap which would defeat any busi- 
ness enterprise and which imposes such limitation of the use- 
fulness and efficient administration of the hospital as to re- 
quire the most serious consideration. The handicap is greater 
in the men's department, where there were 4.31 rotations and 
2.78 months' average tenure, against 3.07 rotations and 3.9 
months in the six State hospitals. Like variation in the women's 
and men's services in other State institutions suggests in- 
herent differences which cannot be discussed at this time. A 
beginning has been made in the endeavor to better these con- 
ditions by advancing the scale of wages to the standard pre- 
vailing in other State hospitals. The result has been more 
satisfactory in the women's department. Further improvement 
may be anticipated if your recommendations to the Legislature 
lead to granting sufficient funds to reduce the hours of duty 
to a sixty-hour-a-week basis. Betterment, however, must nec- 
essarily be gradual, as the fruit of continuous study and persist- 
ent effort to eliminate obstacles. Certain needs are obvious, 
such as more adequate accommodations for families of efficient 
officers and nurses, better conditions of living, inducements to 
enter the service as a vocation, and assurance of reasonable 
provision for old age. 

The Medical Work 
was greatly increased by the demands of the diphtheria epi- 
demic, which almost exhausted at times the energies of physi- 
cians and nurses, who were tireless in their response. Hydro- 
therapeutic measures, such as the wet pack and prolonged bath, 
have been applied with greater frequency in the treatment of 
patients, with good effect. The diminution of mechanical re- 
straint and seclusion of patients is most gratifying, and indica- 
tive of earnest and resourceful effort by physicians and nurses. 
There ha.s been no resort to restraint of a male patient since 



1909.] 



PUBLIC DOCUMENT — No. 84. 



25 



July. An occasional autopsy has been done. There is great 
need of a suitable laboratory for clinical and pathological ex- 
aminations and scientific research. Steps are being taken to 
prepare and equip two rooms designed for this purpose in the 
basement of the Stedman building. The usual clinics have been 
given to the students of the Tufts and Harvard medical schools. 

Repairs and Minor Improvements 
have been made to an average amount but considerably in excess 
of the previous year. Granolithic walks were laid around the 
oval between the B and C buildings and out to the Canterbury 
Street entrance. The old plank siding along Austin Street was 
replaced by a cinder walk. Iron fire escapes were erected from 
the second story at either end of the B building and from the 
first story front and rear, also from wards 5 and 6, 7 and 8, 
and the rear extension of the north wing at the men's depart- 
ment. A granolithic floor was put down in the scullery of the 
men's kitchen. The walk over the basement passage between the 
Walker and Stedman buildings was roofed over and enclosed in 
glass, affording a solarium for the use of tubercular patients 
temporarily, but eventually for other classes. 

Good progress has been made in painting, which should be 
continued throughout the hospital. It has been completed 
in the women's chapel and B building and the exterior of the 
corridors connecting them with the A building, on the interior 
of the men's chapel and six wards, and is now going on in the C 
building. 

Electric fans were installed in the laundry to remove the 
steam from the wash room. The engineer has been energetic 
in improving the heating apparatus. The steam mains under 
A corridor and in other exposed places have been reboxed and 
packed with mineral wool; much naked piping has been insu- 
lated with magnesia covering; long circuits have been cut out 
by short direct connections; several traps have been relocated 
to shorten returns. These alterations and many ordinary repairs 
have been done by the regular engineering force at no addi- 
tional expense, except for a small amount of material. 



26 



BOSTON STATE HOSPITAL. [Dec. 



Gypsy and Browi^-tail Moths 
badly infested the trees and shrubs of the grounds and farm 
The usual methods were employed to destroy them and limit 
their spread, at an outlay of more than $2,000 in doing only 
necessary work. Although many dead or diseased trees were 
cut or trimmed, energetic effort will be required in this direc- 
tion the coming year, especially upon the recently acquired 
property, which was neglected last season. Steps are being 
taken to accomplish this by our own labor as far as possible. 

MAmTENANCE Expenses 
in the gross amounted to $191,980.75, which, divided by the 
average number of patients in the hospital, 767.37, yields a 
gross average weekly per capita cost of $4,798. 

Receipts for board of private patients were $15,552.82; from 
partial payments for board of patients, $6,037.75; from sales 
and other sources, $1,222.38; making a total income of 
$22,812.95. 

Deducting receipts from gi'oss expenses, the net cost of 
maintenance was $169,167.80, which, divided by the above 
average number of patients, yields a net average weekly per 
capita cost of $4,228. 

The gross expenses exceeded those of the previous year by- 
$28,112, which are accounted for in the main as follows: — 



Increase in salaries, wages and labor, $4,665 

Cost of water (not paid by the hospital last year), . . . 4,687 

Excess of repairs and minor improvements, .... 7,013 

Expenses of diphtheria epidemic and investigations, . . 1,695 

Excess in purchase of clothing, 2,431 

Excess in purchase of furnishings, 1,912 ' 

Destruction of gypsy and brown-tail moths (no expense to 

hospital last year), 2,085 

Excess in purchase of live stock, carriages, wagons, etc., . . 3,576 



Total, $28,064 



It may be added that economy prevailed in all city depart- 
ments last year, and it would be natural to expect that during • 



1909.] 



PUBLIC DOCUMENT — No. 84. 



27 



the closing period of municipal administration of the hospital 
general expenses, repairs and improvements, and stock on hand 
would be reduced to a minimum. In confirmation, it appears 
that maintenance expenses were about $7,000 less than the 
previous year, although an average of 52 more patients were 
supported. 

Certain additional demands necessitate the increase of esti- 
mates for maintenance the coming year up to $213,550. An 
average of 53 more patients must be cared for. The advanced 
scale of wages, which was operative only five months last year, 
must be paid for the full twelve months. The reduction of 
hours of work to a sixty-hour-a-week basis will require the em- 
ployment of at least 25 more persons, for whom wages, board 
and room furnishings must be provided. 

The DevelopmeisT of the Hospital 
should proceed according to a well-considered plan. In ac- 
cordance with your instructions preliminary studies have been 
made with reference to (1) the natural approaches, roadways 
and water courses with a view to rendering available every 
building site consistent with proper separation of classes and 
reservation of sufficient spaces for exercise and recreation of 
patients; (2) the location of the administrative center, service 
buildings and heat and power plant in relation to the main 
groups of patients' buildings; and (3) the presentation of a 
comprehensive but tentative scheme for review and gradual 
elaboration. The landscape features are receiving the atten- 
tion of Mr. Arthur A. Shurtleff. Under his direction the 
necessary surveys are being made. 

Certait^ Structural Needs 
are imperative. Facilities for electrical treatment, hydrotherapy 
and other forms of physical therapeutics are indispensable in 
the equipment of the modern hospital. These could be provided 
by an addition to the south end of the Butler building, in which 
a general treatment room might be had on the ground floor 
and provision for prolonged baths and other hvdrotherapeutic 
measures in connection with each of the present wards on the 
first and second floors. 



28 



BOSTON STATE HOSPITAL. 



[Dec. 



The Stedmaii wards were designed for the reception and 
treatment of new patients, and are well adapted to the purpose, 
hut are now crowded with chronic cases of the old, feeble or 
bedridden class. Infirmary buildings should be constructed for 
the care of such patients. Eelief of the Stedman building in 
this way would greatly improve the classification of recent 
cases and add much-needed capacity for patients pressing for 
admission to the hospital. 

The laundry is now much cramped for room and will be 
utterly inadequate to the demands growing out of enlargement 
of the institution. 

The carpenter and machine shops are small and are not 
equipped with machinery and power. 

There is no industrial room for patients. The sewing and 
mending room does not afford space for one-third of the patients 
who might find beneficial and useful occupation in it. 

xVll these purposes might be served temporarily by a building 
which could eventually be utilized solely for a laundry. 

With your approval, working plans, specifications and esti- 
mates for such buildings have been prepared, and are recom- 
mended for submission to the Legislature with your petition for 
appropriations as follows : — 



Constructing- and furnishing an addition to the Butler 
building to provide treatment rooms for acute and curable 
patients, $39,000 

Constructing and furnishing three infirmary buildings suffi- 
cient to accommodate 300 patients, with the necessary 
officers and nurses, 275,000 

Constructing and equipping a building for the extension of 
the present laundry and for temporary use as carpenter 
and machine shops, industrial rooms for patients, and 
other purposes, 44,000 



Dr. E. C. Noble was appointed on the staff of the men's 
department and began his duties March 15. After four and one- 
half years' service in the women's department. Dr. Erancis X. 
Corr resigned November 1, and has opened an office in Warren 
Chambers, Boylston Street. On August 1 Mr. William E. 
Elton had the treasurership added to his duties as steward. 



1909.] PUBLIC DOCUMENT — No. 84. 



29 



Although such a combination is wise under present conditions 
and efficient in operation, and was made on my recommenda- 
tion, nevertheless, as a matter of principle the two offices should 
be kept distinct, and as soon as the growth of the hospital shall 
warrant the additional expense their separation should be 
anticipated. Miss Florence N. Spidle was promoted from as- 
sistant matron to matron in October. 

Our thanks are extended to Dr. John Dixwell and his asso- 
ciates of the Hospital Music Association, to the Dorchester 
Woman's Club and the Harvard Improvement Association 
Choral Union for their very enjoyable entertainments. Maga- 
zines and other reading matter have been gratefully received 
from the Boston Public Library and the Hospital Newspaper 
Society, which have given pleasure to many patients on the 
wards. It is hoped that our old friends may continue to re- 
member us and that new ones may join them in the endeavor to 
brighten the lives of our patients. 

I feel a deep sense of obligation to the faithful officers, nurses 
and employees who have made possible whatever has been ac- 
complished during the year. I am profoundly grateful for 
your patient consideration and wise direction in many per- 
plexing situations. 

Respectfully submitted. 



Nov. 30, 1C09 



OWEN COPP, 

Superintendent. 



30 



BOSTON STATE HOSPITAL. 



[Dec. 



SUPERINTENDENT OF NURSES' REPORT. 



To the Superintendent of the Boston State Hospital. 

The tenth annual report of the Training School for Nurses 
is herewith respectfully submitted : — 



Ida C. Aitken. 
Edith E. Dorey. 
Frances L. French. 
EHzabeth A. Gunn. 



Graduating Class of 1909. 

Elizabeth M. Hartley. 
Catherine McKinnon. 
Ruby L. Sperry. 
Lottie Urquhart. 



Nursing Staff. 

Superintendent of nurses, 1 

Assistant superintendent of nurses (graduate), .... 1 

Head nurses, day (graduates), 6 

Head nurse, night (graduate), . . . . • . . . 1 

Day nurses (gTaduates), . 11 

Night nurse (graduate), 1 

Pupils, day, 10 

Pupils, night, 3 

Probationers, 4 

Attendants, 27 



Applicants during the year, 272 

Applicants accepted, 48 

Probationers accepted as pupils, 12 

Pupils left, 6 

Probationers rejected, 12 



The training school has graduated 8 nurses during the year, 
making a total of 04 nurses since it was organized. Twenty of 
our graduates are still in the hospital, 6 are in charge of build- 
ings, 1 is assistant superintendent of nurses and 1 is night head 
nurse. Seven of our graduates have left during the year, 4 
of whom have entered a general hospital for a post-graduate 
course and 1 is doing private nursing. 



1909.] PUBLIC DOCUMENT — No. 84. 31 



The following subjects are covered : — 

Junior Year. — Bones, joints, muscles, digestion, circula- 
tion, histology, secretion, bandaging, bacteriology, pathology, 
diseases of the bones, fractures and dislocations, skin, urinary 
tract, respiratory tract, hemorrhages, hygiene, chemistry and 
clinical instruction. 

Senior Year. — Tuberculosis, emergencies, sepsis, asepsis, 
antisepsis, surgical dressings, materia medica, gynecology, 
obstetrics, immunity, serum therapy and vaccines, acute infec- 
tious diseases, symptomatology, anatomy and physiology of the 
nervous system, psychiatry, massage, cooking and clinical in- 
struction. 

We again wish to express our appreciation for the assistance 
rendered by the consulting staff and Dr. Linneus A. Roberts, 
who have given courses during the year, also to the resident 
staff for their interest in the promotion of the work. 

Eespectfully submitted, 

JANE EOBEETSON, 

Superintendent of Nurses. 



32 



BOSTON STATE HOSPITAL. 



[Dec. 



VALUATION. 

Nov. 30, 1909. 



Buildings and 153 acres land taken from 

the city of Boston Dec. 1, 1908, . . $1,000,000 00 
79 acres land taken Oct. 1, 1909, assessed 

for 62,710 00 

2%o acres land purchased Nov. 3, 1909, 

for Observation Hospital, . . . 75,919 20 



Provisions and groceries, 


$3,511 


20 


Clothing and clothing materials. 


7,385 


72 


Furnishings, 


42,140 


52 


Heat, light and power : — 






Fuel, . . . . 


722 


00 


Repairs and improvements : — 






Machinery and mechanical fixtures. 


20,620 


00 


All other property, .... 


3,402 


76 


Farm, stable and grounds : — 






Live stock on farm, .... 


6,420 


00 


Produce of farm on hand. 


6,635 


05 


Carriages and agricultural imple- 






ments, 


5,542 


69 


All other property, .... 


974 


00 


Miscellaneous, 


2,564 


56 



$1,138,629 20 



99,918 50 



$1,238,547 70 



1909.] 



PUBLIC DOCUMENT — No. 84. 



83 



TREASURER'S REPORT. 



To the Trustees of the Boston State Hospital. 

I respectfully submit the following report of the finances of 
this institution for the fiscal year ending Nov. 30, 1909 : — 



Institution Receipts. 
Board of inmates : — 
Private, 

Reimbursements, 

Salaries, wages and labor : — 
Wages not called for, . 

Sales : — 
Food, 

Clothing and materials, 

Furnishings, 

Miscellaneous, 

Farm, stable and grounds : - 
Cows and calves. 
Pigs and hogs. 
Hides, 
Sundries, . 

Miscellaneous receipts : — ■ 

Interest on bank balances, 
Rent, 

Sundries, . 



Cash Account, 
Receipts. 



$15,552 82 
6,037 75 



$316 93 
26 71 
14 13 
9 12 



$191 17 
257 14 
45 39 
171 14 



$148 86 
23 GO 
8 44 



Receipts from Treasury of Commonwealth. 
Maintenance appropriations : — 

Advance money, ..... 
Approved schedules of 1909, $174,326 34 
Less returned, ... 12 GO 



$21,590 57 
10 35 



366 89 



664 84 



180 30 



$10,000 GO 

.A 

$'174,314 34 



$22,812 95 



184,314 34 



Total, 



$207,127 29 



34 



BOSTON STATE HOSPITAL. [Dec. 



Payments. 

To treasury of Commonwealth, institution receipts, $22,812 95 

Maintenance appropriations : — 

Eleven months' schedules, 1909, . . . 174,314 34 

November advances, ..... 9,017 21 



Balance Nov. 30, 1909 : — 

In bank, S935 60 

In office, 47 19 



S206,144 50 



982 79 



Total, $207,127 29 

Maintenance. 

Appropriation, $192,000 00 

Expenses (as analyzed below), ....... 191,980 75 



Balance reverting to treasury of Commonwealth, . . . $19 25 



Analysis of Expenses. 

Salaries, wages and labor : — 

General administration, .... $27,394 39 

Medical service, 8,528 60 

Ward service (male), ..... 10,720 79 

Ward service (female), .... 17,298 91 

Repairs and improvements, . . . 3,398 29 

Farm, stable and grounds, . . . . 8^151 20 

Food : — 

Butter, $3,853 84 

Butterine, 2,611 82 

Beans, 642 45 

Bread and crackers, ..... 192 12 

Cereals, rice, meal, etc., .... 983 84 

Cheese, 1,191 52 

Eggs, 3,100 72 

Flour, 4,930 85 

Fish, ....... 1,815 97 

Fruit (dried and fresh), .... 1,573 73 

Meats, 11,161 54 

Milk, • 42 79 

Molasses and syrup, . . . . . 261 43 

Sugar, 2,979 66 

Tea, coffee, broma and cocoa, . . . 2,012 09 

Vegetables, 1,161 46 

Sundries, 2,554 61 

Clothing and materials : — 

Boots, shoes and rubbers, . . . . $1,133 50 

Clothing, 3,262 42 

Dry goods for clothing and small wares, . 1,605 72 

Furnishing goods, ..... 551 43 



$75,492 18 



41,070 44 



Amounts carried forward, .... $6,553 07 $116,562 62 



1909/ 



PUBLIC DOCUMENT — No. 84. 



35 



Amounts brought forward, 



),553 07 $116,562 62 



Clothing and materials — Con. 
Hats and caps, . 
Leather and shoe findings, . 
Sundries, .... 

Furnishings : — 

Beds, bedding, table linen, etc., . 

Brushes, brooms. 

Carpets, rugs, etc., 

Crockery, glassware, cutlery, etc., 

Furniture and upholstery, 

Kitchen furnishings. 

Wooden ware, buckets, pails, etc., 

Sundries, .... 

Heat, light and power : — 

Coal, .... 
Electricity, ... 

Oil, 

Sundries, . . . . , 

Repairs and improvements : — 
Cement, lime and plaster, 
Doors, sashes, etc.. 
Electrical work and supplies, 
Hardware, 

Lumber, .... 
Machinery, etc., . 
Paints, oil, glass, etc., 
Plumbing, steam fitting and suppl: 
Roofing and materials, 
Sundries, . . ... 



Farm, stable and grounds : — 
Blacksmith and supplies. 
Carriages, wagons, etc., and repairs. 
Fertilizers, vines, seeds, etc.. 
Hay, grain, etc., 
Harnesses and repairs, 
Horses, 
Cows, 

Other live stock, 
Rent, ... 
Tools, farm machines, etc., 
Sundries, . 

Miscellaneous : — 

Books, periodicals, etc.. 

Chapel services and entertainments. 

Freight, expressage and transportation. 

Funeral expenses. 

Gratuities, .... 

Hose, etc., ..... 

Medicines and hospital supplies, . 



53 07 
8 80 
14 00 



$4,848 72 
366 70 
534 95 
760 16 
478 50 
494 55 
58 40 
1,252 67 



$18,982 51 
14 70 
107 15 
693 60 



$75 62 
299 89 
193 22 
637 01 
560 75 
527 54 
1,595 57 
1,459 45 
40 72 
4,025 11 



$683 05 
2,979 48 

720 43 
4,308 37 

201 72 
1,245 00 

915 00 
30 

1,500 00 
247 16 
2,952 75 



$174 33 
1,277 90 
109 52 
10 15 
142 90 
111 93 
2,336 12 



6,628 94 



8,794 65 



19,797 96 



9,414 88 



15,753 26 



Amounts carried forward, 



$4,162 85 $176 952 31 



36 



BOSTON STATE HOSPITAL. 



[Dec. 



Amoxmts brought forward, 



$4,162 85 $176,952 31 



Miscellaneous — Con. 

Medical attendance, nurses, etc. (extra) 
Postage, .... 
Printing and printing supplies, 
Return of runaways, . 
Soap and laundry supplies, . 
Stationery and office supplies. 
Travel and expenses (officials), 
Telephone and telegraph. 
Tobacco, .... 
Water, .... 
Sundries, .... 



1,380 94 
313 42 
194 11 
19 75 

1,678 47 
770 07 
168 03 
459 99 
520 64 

4,687 20 
672 97 



15,028 44 



Total expenses for maintenance. 



$191,980 75 



Special Appropriations. 
Appropriations for fiscal year, ....... $600,000 00 

Expended during the year (see statement annexed), . , . 81,025 92 



Balance Nov. 30, 1909, $518,974 08 



Resources and Liabilities. 
Resources. 

Cash on hand, $982 79 

November cash vouchers (paid from advance money), 9,017 21 
Due from treasury of Commonwealth account 

November, 1909, schedule, .... 7,666 41 

$17,666 41 



Liabilities. 

Schedule of November bills, 



$17,666 41 



1909.] 



PUBLIC DOCUMENT — 



No. 84. 





00 


B 

w 


o 

1 






















CQ 




o 






OS 


■a . 




c a 








X 

W 






- 


a . 




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lO 




CM 


xpend 
Fisca 




00 


w 






8 


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O 

S 


o 

O 


•< 










o 




o 




o 












i- 






Ph 


o 


o 


oT 




o 




Acts 19 




i go 












o C ^ 




















^ a; ^ 


















H 




n 
O 


of establi 
for the fi 
atients 
ible ment 




pose 
pital 
al p 
I cura 






t-i 03 ^ ^ 




2 2 ^ s 








OJ 03 S a; 




:2 c = 









I— ( ai 



O 



o 

d 4 ^ ^ 



38 



BOSTON STATE HOSPITAL. 



[Dec. 



LIST OF PERSONS 

Regularly employed at the Boston State Hospital. 



Superintendent, 

Assistant superintendent (per year), 
Assistant physician (per year), 
Assistant physician (per year), 
Assistant physician (per year), 
Assistant physician (per year). 
Treasurer and steward (per year) 
Chief engineer (per month). 
Farmer (per year), 
Assistant farmers (2) (per month). 
Gardeners (2) (per month), 
Matron (per month) , 
Superintendent of nurses (per year), 
Assistant superintendent of nurses (per month). 
Stenographers (3) (per month). 
Clerk (per month). 
Typewriter (per month). 
Seamstresses (2) (per month), 
Laundryman (per month), 
Laundry teamster (per month), 
Laundress (per month). 
Laundresses (9) (per week). 
Baker (per month), . 
Assistant steward (per month), 
Supervisor (man) (per month). 
Supervisors (women, 2) (per month). 
Assistant supervisors (men, 2) (per month). 
Attendants (men, 34) (per month), 
Attendants (women, 27) (per month). 
Nurses (women, 34) (per month). 
Office attendant (per month). 
Table girls (6) (per week), . 
Chambermaid (per week), . 
Cooks (men, 2) (per month). 
Cooks (women, 3) (per month). 
Assistant cook (man) (per month). 



None 
$2,500 00 
1,800 00 
1,400 00 
1,000 00 
700 00 
1,800 00 
120 00 
1,000 00 
$30 00 to 40 00 
35 00 to 55 00 
40 00 
800 00 
45 00 
00 to 65 00 
45 00 
30 00 
00 to 35 00 
40 00 
30 00 
40 00 
00 to 4 60 
60 00 
50 00 
62 00 
35 00 
$30 00 to 45 00 
25 00 to 30 00 
20 00 to 25 00 
20 00 to 30 00 
30 00 
4 00 
4 00 

$55 00 to 70 00 
22 00 to 25 00 
35 00 



$30 



$4 



1909.] 



PUBLIC DOCUMENT — No. 84. 



39 



Kitchen girl (per week), ..... 


$4 00 


Painter (per month), ..... 


70 00 


Painfprs (2^ fner week^ 


L5 00 


ItXcXt Ul Coo llliXlVd i.LL\JLl.yjLLJ y • • • • 


20 00 


Assistant enffineers (1^ fner week") 


21 00 


Assistant engineer, with board and lodging (per week). 


17 55 


T^irpmpn (4^ fr)pr wppk^ 


17 '^0 


StnWpmpn (2^ (^npr months 


$30 00 to 35 00 

t\\JtJ\J \J\J \J\J KJ*_J \J\J 


OVifiiiffpiir (^r>pr Tnnnth^ 


25 00 


Expressman (per month) , . 


45 00 


Teamsters (7) (per month), .... 


$25 00 to 28 00 


Farm hands (5) (per month), .... 


25 00 to 28 00 


Herdsman (per month), ..... 


45 00 


Watchman (per month), ..... 


50 00 


Carpenters (2) (per month), .... 


70 00 


Carpenter (per week) , ..... 


15 00 


Porters (2) (per month), ..... 


$28 00 to 30 00 



40 



BOSTON STATE HOSPITAL. 



[Dec. 



PRODUCTS OF THE FARM AND GARDEN. 



Garden Products. 

Asparagus, 5j boxes, ....... $22 31 

Beans, shell, 16 bushels, 20 00 

Beans, string, 101^ bushels, ...... 101 50 

Beets, table, 250 bushels, . . 125 00 

Beets, table, 6 bunches, ....... 60 

Beet greens, 80 bushels, 28 00 

Cabbages, f ton, ........ 15 00 

Carrots, 277 bushels, 166 20 

Cauliflower, 752 heads, ....... 75 20 

Celery, 114 boxes, 96 90 

Corn, sweet, 357 bushels, 267 75 

Cress, 35 bunches, ........ 3 50 

Cucumbers, 9^ boxes, ....... 18 50 

Cucumbers, pickling, ^ bushel, ....... 80 

Dandelions, 4 bushels, . . . . . . . 3 00 

Kohl-rabi, 37 bushels, 18 50 

Lettuce, 320 boxes, 240 00 

Mint, 35 bunches, 1 75 

Onions, 488 bunches, 9 76 

Onions, 202 bushels, 171 70 

Parsley, If bushels, ....... 88 

Parsnips, 204 bushels, 153 00 

Peas, green, 81 bushels, . . . . . . . 81 00 

Peppers, 2 bushels, ........ 1 50 

Potatoes, 2,556 bushels, 2,328 20 

Potatoes, small, 125 bushels, ...... 25 00 

Radishes, 76 dozen bunches, . . . . . . 19 00 

Rhubarb, 4,998 pounds, •. 99 96 

Spinach, 21 3f bushels, 85 50 

Squash, winter, 5% tons, . . . . . . . 155 00 

Squash, summer, 2,098 pounds, ..... 20 98 

Tomatoes, ripe, 211^ bushels, ...... 158 63 

Tomatoes, green, 52 bushels, ...... 26 00 

Turnips, 314 barrels, 392 50 

Apples, 20f barrels, 62 25 

Blackberries, 537 boxes, ....... 53 70 



1909.] 



PUBLIC DOCUMENT— No. 84. 



41 



Currants, 591 boxes, $65 01 

Grapes, 1,303 pounds, 39 09 

Pears, 18 bushels, 18 00 

Raspberries, 67 boxes, ....... 6 70 

Strawberries, 7,265 boxes, . . . . . . 581 20 



Total, 



$5,759 07 



Farm Products 

Ensilage, 190 tons, . 
Fodder, green, 322 tons, . 
Fodder, dry, 4 tons. 
Hay, 165 tons. 
Hay, bedding, 22 tons. 
Mangel-wurzel, 1,025 bushels. 
Manure, 420 cords, . 
Beef, 4,913 pounds, . 
Calves, 42, . 
Milk, 189,669 quarts, 
Pork, 19,495 pounds. 
Ice, 700 tons, . 
Wood, 20 cords. 

Total, 

Garden products. 
Farm products. 



Total, 



$27,994 28 



STATISTICAL TABLES. 



[Form prescribed by State Board of Insanity.] 



-H CO ' ' 

00 Tf< C<5 



I <-l OO CO 00 l« M I 



«otooooo<Mooc<iT»<co>cc<i05r^ 

00 CD 00 <-l IC «5 05 <M — CO (N 
i-H IM ^ 



I 05 05 eo 05 » 



<'!f<CO'-lrtOOCOt^OO»0(Mt^ 
) Tf< CO CI T-1 



C<lO'>tiC0Ot£>l005C^O' 



CO CO 05 



coco I CO 00 00 lO IC CO CO lO 
t>. IfS »r5 CO CO CO 05 O 00 CO ■<* >— I 



•^'-^eoooO'<f'-H-*iO'-i050i 



S - 



_ S 5:2:2 Mb 



-5 '"O' 

rj p S e 



^11 ^ £ « 



• § cf "*^ ^ TO TO S 
. a"-S'S Q, a3 53 a3 a3 

oj a> a) 0) 0) 
^.Sw £ asa it! ic it: ta to 



T5 C > 



000000 



ri-l 

e s a H s s 

3 3 3 3 3 3 



46 BOSTON STATE HOSPITAL. [Dec. 



2. — Insane received on First and Subsequent Commitments. 





Cases committed. 


NUMBER OF COMMITMENT. 










Males. 


Females. 


Totals. 




132 


166 


298 




10 


15 


25 




2 


5 


7 




1 


2 


3 


Fifth to this hospital, 


1 








146 


188 


334 


Total persons 


145 


186 


331 


Never before in any hospital for insane, .... 


123 


151 


274 



3. — Nativity and Parentage of Insane Persons first admitted to Any 

Hospital. 



PLACE OF NATIVITY. 


Males. 


Females. 


Totals. 


03 


Fathers. 


Mothers. 


Patients. 


Fathers. 


Mothers. 


Patients. 


Fathers. 


Mothers. 


Massachusetts, .... 


52 


10 


12 


57 


17 


21 


109 


27 


33 


Other New England States, . 


6 


7 


6 


8 


11 


7 


14 


18 


13 


Other States, 


8 


7 


6 


9 


7 


7 


17 


14 


13 


Total native, .... 


66 


24 


24 


74 


35 


35 


140 


59 


59 


Other countries: — 




















Africa 








1 






1 






Austria 


1 


1 


1 


1 






2 


1 




Belgium, 


1 


1 


1 








1 


1 


1 


Canada, 


12 


14 


13 


22 


17 


21 


34 


31 


34 


England, 


3 


4 


4 




5 


3 


4 


9 


7 


Germany, 


4 


5 


5 


5 


8 


8 


9 


13 


13 


Holland 




1 












1 




Ireland, 


28 


58- 


60 


40 


69 


71 


68 


127 


131 


Italy, . . ■ . 


2 


3 


2 


1 


2 


2 


3 


5 


4 


Portugal 












1 




1 




Russia 


2 


3 


3 


2 


4 


4 


4 


7 


7 


Scotland 


2 


4 


4 


1 


4 


1 


3 


8 


5 


Sweden, 


2 


2 


2 


2 


2 


2 


4 


4 


4 


Switzerland 










1 






1 




Total foreign, . . . ^. 
Total native, .... 
Unknown, 

Totals 


57 
66 


96 
24 
3 


96 
24 
3 


76 
74 
1 


113 
35 
3 


113 

35 
3 


133 
140 
1 


209 
59 
6 


209 
59 
6 


123 


123 


123 


151 


151 


151 


274 


274 


274 



1909.] PUBLIC DOCUMENT — No. 84. 47 



4. — Residence of Insane Persons admitted by Commitment. 





First 

ADMITTED TO AnY 

Hospital. 


Other 
Admissions. 


Totals. 






i 












73 






03 


a 


tn 




M 
a 


03 


m 


d 

n 
a 








,^ 


o 
H 






o 
H 






p 


M£iss&chus6tts — 




















SuflFolk County, .... 


121 


139 


260 


22 


33 


55 


143 


172 


315 


Essex County, .... 




1 


1 










1 




Middlesex County, .... 




3 


3 










3 


3 


Hsmipshire County, 






1 










1 


1 


Norfolk County, .... 


] 




2 








1 


1 


2 


Plymouth County, .... 






1 


_ 








1 


1 


Worcester County 






1 




1 


1 




2 


2 


Total resident, .... 


122 


147 


269 


22 


34 


56 


144 


181 


325 


Canada, 






1 










1 


1 


New Hampshire, .... 






1 










1 


1 


Pennsylvania, 






2 








1 


1 


2 


New York, 










1 


1 




1 


1 


Rhode Island, 




1 


1 










1 




Total nonresident, . 

Cities or towns 10,000 or over, 
County districts under 10,000, 


121 
2 


4 

150 
1 


5 

271 
3 


22 


1 

35 


1 

57 


1 

143 
2 


5 

185 
1 


6 

328 
3 



6. — Civil Condition of Insane Persons first admitted to Any Hospital. 







Males. 


Females. 


Total. 


Unmarried, 


47 


60 


107 




52 


64 


116 




23 


26 


49 


Divorced, 


1 




2 


Totals 


123 


151 


274 



48 BOSTON STATE HOSPITAL. [Dec. 

6. — Occupation of Insane Persons first admitted to Any Hospital. 



MALES. 



Bartenders, 


2 


Metal worker. 


r 




2 


IVTn c!ir>i p n «! 


9 




2 


J. dlllLCi , 


1 

X 


Contractor, 


1 


Pedler 


1 




1 


n Q TTY1 Q ^^ d'f 


1 

L 


Conks 


4 


X ILlllllLJdj • • 


1 


Engineer, 


. 1 


Salesmen, 


. 11 


Firemen, 


. 4 


Shoemakers, 


. 4 


Inspector, 


. 1 


Student, 


1 


Janitors, 


. 2 


Tailors, 


. 3 


Laborers, 


. 32 


Teamsters, . 


. 6 


Mariner, 


. 1 


Typewriter, . 


. 1 


Mason, 


.1 


None, . 


. 30 


Mechanics, . 


. 4 






Merchants, . 


. 2 




123 


FEMALES. 


Actress, 


1 


Milliners, 


. 2 


Bookkeepers, 


. 2 


Nurse, . 


1 


Cook, . 


. 1 


Stenographer, 


. 1 


Domestics, . 


. 9 


Teachers, 


. 2 


Dressmakers, 


. 3 


Waitress, 


. 1 


Factory girl, 


. 1 


None, . 


. 49 


Governess, 


. 1 






Housework, . 


. 72 




151 


Laundresses, 


. 5 







1909.] 



PUBLIC DOCUMENT— No. 84. 



Died. 


AT DEATH. 


Totals. 


1 |(MC^I>(MOOfOOCOCO 
m rM rvi rvi 

T— 1 


<M 1 
CO 


132 
55.98 


Females. 


1 |i— ii— ii-Hi-HiOtOrtHOCDCS 

1— 1 1-H 1-H r— 1 


CO 1 


73 
59.36 


Males. 


1 |7-lT-ICO'-llOlOOOI>Tt< 


1 


59 
52.60 


AT FIRST ATTACK. 


Totals. 


rH(M(MCOI>050000rHrHCX) 

rNi rvi r<i rvj 

^•N 


CM 1 
CO 


132 
47.59 


Females. 






73 
55.15 


Males. 


T— 1 


Oi 1 

to 


59 
40.02 


First admitted to Any Hospital. 


WHEN ADMITTED. 


Totals. 


1 C^OO^OSOSCOfMiOTHOOO 
r<i ^-1 rvi "rW rvi ro 


CM 


274 
45.84 


Females. 


1 T-HCOOt^COCO-^THCOt^CO 

1-Hi— li— li— ICOC^r— It— 1 


to ' 


151 
45.09 


Males. 


1 i-l'!tlCi(NCDCO00'-HT-HC0tO 

T— 1 1— 1 C^l <N T-H 1— 1 


CO 1 
CM 


123 
46.59 


AT FIRST ATTACK. 


Totals. 


Oii-HT-Hi-itOT-HOOOOOcOCOTtH 

■ /-VI <-vi f^i rvi 

1-n UN| C.N t-N ^•N UN UN 


O T^^ 
CM 


^ lO 
CM 


Females. 




O rH 

•o 


151 
44.04 


Males. 


rH T-H CM rH rH T-l 


O CO 
CM 


123 
45.95 




Congenital, 

15 years or less. 

From 15 to 20 years, 
20 to 25 years, 
25 to 30 years, 
30 to 35 years, 
35 to 40 years, 
40 to 50 years, 
50 to 60 years, 
60 to 70 years, 
70 to 80 years. 

Over 80 years, 

Totals, 
Unknown, 

Total of persons. 

Mean known ages (in years). 



50 



BOSTON STATE HOSPITAL. 



[Dec. 



I I I I I I 



I I I I I 



05 tn 



I >0 M CO IM ' 



CO CO -rf* 00 lO 
1-1 (M 



111 s I- a 



pro . - w 
<!j <; O O O Q W O P ^ ^5 1-] S Ph 02 «i H ^ 



-5 « 



1909 .] PUBLIC DOCUMENT — No. 84. 51 



9. — Probable Duration of Mental Disease before Admission. 



PREVIOUS DURATION. 


FiBST ADMITTED TO AnY HOSPITAL. 


Males. 


Females. 


Totals. 


Congenital, ...... 


5 


4 


9 


Less than 1 month, ..... 


15 


36 


51 


From 1 to 3 months, .... 


24 


20 


44 


3 to 6 months, .... 


20 


15 


.S5 
«jo 


6 to 12 months, .... 


1 


1 7 


OU 


1 to 2 years, ..... 


19 


22 


41 


2 to 5 years, ..... 


1 

lo 




oo 


5 to 10 years, .... 


5 


9 


14 


10 to 20 years, .... 


2 


4 


6 


Totals, 


116 


150 


266 


Unknown, . . . . 


7 


1 


8 


Totals, 


123 


151 


274 


Average known duration (in years), . 


1.37 


1.35 


1.36 



BOSTON STATE HOSPITAL. [Dec. 



Aggregates. 




M 05 IC ^ i-l »0 O ?0 <N <N O lO 1 «0 (N 1 1 O 

1 ^ 




Tt< (M — 1 CO 








2 


Died. 




1 -"tl 00 <M (M ^ Tf< 03 CO (M lO <M ^ 1 1 1 1 1 1 
r-< ^ CO CO 








<s> 




|iO(M-H| 1 1 IO>C<>(M>-^|rt| 1 1 1 1 1 


s? 


Discharged. 


NOT 

improved. 




1 t^OlM III 1 1--.1-C 1 CO 1 1 1 <-! 1 1 1 


CO 


•saiBuiaj 


1 «0 CO 1 1 1 1 1 »ft tH 1 T.H CO 1 1 1 "-H 1 1 1 


CO 

<M 




I-HIC^JIII ((MIICOIIIIIIll 


00 


improved. 




loooO'rt^i 1 t^'ifii-iicoie^noiici 1 1 


<D 


•saiBuia^ 


1 1 ^ 1 1 1 1 1 1 1 1 1 1 1 f 


00 




1 COO'-I III 1 ■<*< — 1 CO 1 -H Ttl 1 1 1 1 


00 

ca 


capable op 
self-support. 




ICO!MIIII ll'-Hllt-i-^t^lllll 






IC^^IIII lllll'-^IOIIIII 


o 








recovered. 




^OIIrHII -^IIIII^IIICOII 
CO 


OS 
CO 




'"'^ 1 1 ^ 1 1 1 1 ^ 


CO 




leoillll llllll-Hlll-ill 


00 



•sp^ox 



»«00»OTt<OOt~-.»C-<!t<-^05CO(MT*< 



«0 O Tfl CO ^ 



I50CO I (M«0^iOtJ<.^CO I <N 



- .3 ^ 

a 



CCS >> M 

i i i -J 

§ S o^^'^^^J-^ a-S S ^ii «ii s 2 2 



1909.] PUBLIC DOCUMENT — No. 84. 53 



OO^M CO <N (M >-i M ^ (M --^ 
<M —1 


»o ic 

CO CO 




oo g g 




t-- 05 05 




»fl <M <M 
r-H CO fO 


<M 1 1 "H r-H 1 ^ 1 1 1 


CO CO 


^ 1 ^ 1^1 1 1 ^ 


to 05 « 


^(M—l 1 1 1 1 '-H 1 1 1 


iC O «D 
CO CO 


1 1 1 1 1 'H 1 1 1 


Tj< 1^ 


11'"' 1 1 1 1 1 1 1 1 


rH 05 Oi 


--I 1 1 1 1 1 1 1 1 1 


o 


OOPO 1 1 1 1 1 1 1 1 1 


05 C5 
T-H CO CO 


CO (M 1 1 1 1 1 1 1 1 1 


"5 CO CO 
CO CO 


rtrH 1 ^ 1 ,H 1 1 1 (M 1 


O -H ^ 


III 1 1 1 1 1 1 <M 1 


C<l C<l <M 


' —1 1 1 1 1 1 1 


^ o a> 


C^i-H 1 _ 1 1 1 1 1 1 


»o 

i-H lO U5 


1 l-H 1 1 1 1 ^ 1 1 


les \o 

,-1 


'-III 1 1 1 1 1 1 1 1 


^ Ci 05 


CO i-l 


O 

«0 CO CO 
CO CO 


O 1 1 1 i-H i-H 1 1 

<N 


00 o 

CO 00 00 


05 lO 1-1 C<l CO 1 C<J 1 1 1 tH 


CO «o 

(M 'Jt 


B. — Other admissions: — 

Manic-depressive insanity, .... 

Invokition psychoses: — 
Melancholia, 

General paresis, 

Alcoholic insanity, acute, 

Alcoholic insanity, chronic, .... 
Imbecility 

Totals 

Aggregate persons 



BOSTON STATE HOSPITAL. 



Totals. 




o oq C5 T^^ 1 Lo o i 

00 CM i-H o 
CM CO CM 




I>- Ci o 

CD I— 1 

r— 1 


00 

01 lO 
1—1 1—1 




CO CO CO 1 
rH 


05 CM 
1-1 o 
1—1 1—1 


Died. 


•s^ox 


^ CD CM 1 

CM 

1—1 


C^l C: 
CO 1-1 




^ CM 1 

CD 


CO CO 
CD 




CM 1 1 


05 CO 


Not improved. 




CM CO 1 
CO 


CO 1— < 

CO CO 




rt^ CO 1 1 
CM 


CO 

CM CM 




00 1 1-1 1 


O 00 


Improved. 


•eiB^jox 


CM CD CO 1-1 
CD 


CM CO 




O CO CM T-H 

CO 


Oi 00 

CO CM 




CM 1 T-H 1 
CO 


CO 00 
CO CM 


Capable op 
Self-support. 


•si^^ox 


1> CM 1-1 1-1 


1-1 lO 
CM T-i 




O 1^ I ^ 


CM O 

T— 1 T— 1 


•S8I'BJ\[ 


^ ^ 1 


Oi lO 


Recovered. 


•siB^jox 


>0 »0 CM CM 


^ Ci 
lO CO 




CO lO CM CM 
CO 


CO 




05 1 1 1 


Ci 00 


NUMBER OF THE ADMISSION. 


First, 

Second, 

Third, 

Fourth, 

Totals, 

First admitted to any hospital, . 



1909.] 



PUBLIC DOCUMENT — No. 84. 



< 




1 .-H ^ 1 








1 "5^ 




1 ^ 

1 


Senii 
Demen 




1 »-l (M rH 1 






1 1—1 


1 CO 1 




CO 


■S8J'BJ\[ 


i 1 1 1 1 




r-l lO 1 1 




1 CO 1 




o 


i J «^ 








1 "-H CO 1 










Invoi, 
TioN Me 


*S9J'BIXI8^ 
















■S8J'BJ\[ 


1 1 1 1 1 1 1 1 1 1 1 1 1 ^ 1 III III 1 




H 








J 
O 
« 




1 1 1 1 1 1 1 I 1 1 1 1 1 1 1 III III 1 




















e 














ION 
)SIS. 
















CO 


FECT 
YCHC 






1 
















■ 




pi 

ii 
&^ 




1 1 CQ 1 1 








1 1 1 




»o 


*S9J^UI9^hf 






1 1 1 1 




















1 1 1 




CO 


SIVE 
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56 



BOSTON STATE HOSPITAL. [Dec. 





•ep^^ox 
















\CUTE 

FUSIONAL 

SANITY. 


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Acute 
Alcoholic 
Insanity. 


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Insanity. 


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Dementia. 


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CAUSES. 


General diseases: — 
Alcoholism, 

Tuberculosis, pulmonary, 

Mj-xoedema, 

Nervous system: — 
Paralysis agitans, 

General paresis, 

Acute delirium, 

Exhaustion of manic-depressive insanity, 

Chronic leptomeningitis, 

Circulator^' system: — 

Cardiac insufficiency 

Organic heart disease, 

Cerebral hemorrhage, 

Respiratory system: — 

Hypostatic pneumonia, 

Broncho pneumonia 

Digestive sj'stem: — 

A ppendicitis, 

Enteritis, acute, 

Enteritis, chronic, 

Genito-urinary system ; — 

Nephritis, chronic, 

Totals 



1909.] 



PUBLIC DOCUMENT — No. 84. 



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58 



BOSTON STATE HOSPITAL. [Dec. 1909. 



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Public Document No. 84 




SECOND ANNUAL REPORT 




OF THE 

TRUSTEES 




OF THE 

Boston State Hospital, 




For the Year ending Nov. 30, 1910. 




BOSTON: 

WRIGHT & POTTER PRINTING CO., STATE PRINTERS, 
18 Post Office Square. 
1911. 





Public Document 



No 84 



SECOND ANNUAL REPORT 



OF THE 



TEUSTEES 

OF THE 

Boston State Hospital, 

For the Yeak ending Nov. 30, 1910. 




/^^ BOSTON: 
WRIGHT & POTTEE PRINTING CO., STATE PRINTERS, 
18 Post Office Square. 
1911. 



JAN 2.1 iya 

■USE, EOSTOW 



Approved by 
The State Board of Publication. 



3 



CONTENTS. 



PAGB 

Report of Trustees, 7 

Report of Superintendent, 15 

Report of Superintendent of Nurses, 33 

Report of Treasurer, 36 

Statistics, 45 



OFFIOEES 

OF THE 

BOSTON STATE HOSPITAL. 



TRUSTEES. 

Walter Channing, M.D., Chairman, ..... Brookline. 

Henry Lefavour, Secretary, ....... Boston. 

Mrs. Henrietta S. Lowell, ....... Brookline. 

Joseph Koshland, ......... Boston. 

Mrs. Katherine G. Devine, ....... Boston. 

WilLiam Taggard Piper, ....... Cambridge. 

Michael J. Jordan, ........ Dorchester. 



Stated meetings of the trustees are held at the hospital on the second Tuesday 
of each month. 



OFFICERS. 



Henry P. Frost, M.D., . 
Samuel W. Crittenden, M.D., 
George H. Maxfield, M.D., . 
Mary E. Gill, M.D., 
Ermy C. Noble, M.D., . 
Stephen E. Vosburgh, M.D., 
Harry M. Nicholson, M.D., . 
Myrtelle M. Canavan, M.D., 
William E. Elton, 
Jane Robertson, . 
Jessie M. Buist, 
Florence N. Spidle, 
Arthur E. Morse, 
Louis S. White, 



Superintendent. 
Assistant Superintendent. 
First Assistant Physician. 
Assistant Physician. 
Assistant Physician. 
Assistant Physician. 
Junior Assistant Physician. 
Pathologist. 

Treasurer and Steward. 

Superintendent of Nurses. 

Assistant Superintendent of Nurses. 

Matron. 

Chief Engineer. 

Farmer. 



VISITING COMMITTEES, 1910-11. 



February, ...... Mrs. Devine and Mrs. Lowell. 

March, ....... Mr. Lefavour and Mr. Koshland. 

April, ....... Mr. Jordan and Mr. Piper. 

May, ....... Dr. Channing and Mr. Koshland. 

June, ....... Mrs. Devine and Mrs. Lowell. 

July, Dr. Channing and Mr. Piper. 

August, ....... Mr. Lefavour and Mrs. Lowell. 

September, ...... Mr. Koshland and Mr. Jordan. 

October, ....... Mrs. Devine and Mrs. Lowell. 

November, ...... Mr. Lefavour and Mr. Piper. 

December, ...... Mr. Koshland and Mr. Jordan. 

January, ...... Dr. Channing and Mrs. Devine. 



©be Olommontoealtl) of ittaasacbusctts. 



TRUSTEES' REPORT. 



To His Excellency the Governor and the Honorable Council. 

The trustees of the Boston State Hospital have the honor to 
present herewith their second annual report. 

Development of the Hospital. 

In the last report it v^as stated that the trustees and the 
superintendent had devoted much attention to the study of 
plans for the development of the hospital, the expectation being 
that several thousand patients must be provided for in the 
future. As a result of further deliberations a general layout 
of buildings, subject to modification, has been decided on as 
follov^s : at the corner of Austin and Canterbury streets a recep- 
tion group for both sexes; an industrial group for women on 
Canterbury Street, which will provide for quiet cases able to 
work, and some of whom will eventually recover; a custodial 
and infirmary group for both sexes is already being erected 
not far from the buildings at the men's department, and there 
will be a second one for the same class of patients ; at the corner 
of Walkhill and Harvard streets an industrial group for men; 
then to the north, on Harvard Street, a group of farm cottages 
for male patients. These various buildings all have sightly 
locations, and, while not too near, are well placed in relation 
to each other and convenient of access and administration. It 
will be seen that the plan outlined provides for a large number 
of patients, from those, on the one hand, needing thorough hos- 
pital treatment, to those, on the other, who have become chronic 
and capable of doing only the simplest kind of outdoor work. 

As a first step toward the enlargement of the hospital the 



8 



BOSTON STATE HOSPITAL. 



[Dec. 



trustees asked, in their last report, for an appropriation of 
$358,000; $275,000 to be expended on an infirmary group for 
300 patients ; $39,000 for an addition to the Butler building, 
for the treatment of acute cases ; and $44,000 for a laundry 
building, which would also provide room for some of the in- 
dustrial occupations. 

' The Legislature granted the appropriation toward the end of 
the session of 1910. As soon after as possible the necessary 
proposals for all the buildings were advertised, and contracts 
awarded in September. Work was begun immediately, and at 
the date of this report is well under way. The foundations 
of the basement of the infirmary buildings are finished, and 
laying the brick for the walls will begin at once. The laundry 
and the Butler addition will soon be roofed in. Both the latter 
buildings should be ready for use in the spring of 1911. The 
Butler addition has wards for acute cases, with prolonged baths. 
The whole building will furnish very complete and much-needed 
facilities for treatment. In the basement the hydrotherapy 
plant, electrical, massage, rest and dressing rooms are located. 
The laundry building will make it possible to employ many more 
patients in that department, and give more room for shops for 
industries. 

Psychopathic Hospital. 

A further step in the development of the hospital will be 
the erection of the psychopathic hospital. Last year, under the 
heading of the " Hospital for the First Care and Observation 
of Acute Cases," we stated that land had just been purchased for 
a site at the corner of the Parkway, Brookline Avenue, Fenwood 
Road and Vila Street. 

Preliminary plans for a building had already been made by 
the State Board of Insanity for another site, and it was hoped 
that these might be to some extent available. While they have 
been suggestive, numerous problems have arisen in designing 
a building for which there was practically no precedent, and 
many months of hard work have been expended by Dr. Copp, 
who has acted as agent of the building committee, Messrs. Ken- 
dall, Taylor & Co., the architects, and French & Hubbard, 



1910.] 



PUBLIC DOCUMENT — No. 84. 



9 



engineers. Working plans and specifications for the construc- 
tion of the building were finally ready, and bids were advertised 
for in October and the contract awarded early in November. 
At the present date the basement has been excavated and the 
forms for the concrete foundation are being put in place. The 
contract calls for the completion of the building January, 1912, 
and, unless unforeseen difficulties arise, the hospital should be 
open for patients in the late spring of 1912. 

Tempoeary Caee Cases. 

The trustees were requested by the State Board of Insanity, 
under chapter 307, Acts of 1910, to assume, on May 1, 1910, 
the temporary care and observation of persons suffering from 
mental disorders who should come under the care of the police 
in the city of Boston, pending examination and commitment. 
To make proper provision for them, it was necessary to vacate 
the Butler building, which had hitherto been used for disturbed 
and excited women. One floor was set apart for men and one 
for women. The total number received from May 1 to Decem- 
ber 1 has been 198 ; 115 of these being men and 83 women. 
When the addition to the Butler building is completed, the facil- 
ities for treating these patients will be much improved. The 
added care and expense of looking after such a large increase 
in the admissions have been considerable, but such admissions 
have made the medical service more active, and been one of 
the means leading to a better classification of the patients, which 
the superintendent is gradually accomplishing. 

Administratiois'. 
In the previous report attention was called to the difficulty 
of administering the departments for men and women, which 
had hitherto been very much like two separate institutions with 
many duplications and consequent waste of time and money. 
The effort has been made to centralize the management of the 
medical and business affairs at the women's department. The 
superintendent and the steward, who is also the treasurer, have 
their offices at this department, and the stores for the whole insti- 



10 



BOSTON STATE HOSPITAL. 



[Dec. 



tution are kept there. All temporary care cases, both male and 
female, are received at this department, and the new laboratory, 
which is already doing excellent work, is in the basement of one 
of the buildings. The Butler addition, the new laundry, the pro- 
posed service building, the electric light plant and the already 
installed central telephone exchange are all located there, with 
the idea of gradually doing away with unnecessary duplication, 
and making management from one center efficient and economi- 
cal. As the institution increases in size, the wisdom of so doing 
wiirbecome more and more apparent. 

It can be said, without exaggeration, that the spirit pervading 
the institution has gone on steadily improving since our last 
report. The change is noticeable from the medical officers 
through the whole staff of employees. The quality of work is. 
better, and a spirit of cheerful co-operation pervades the entire 
hospital. The trustees are gratified at the advance made in this 
direction. 

Occupation of Patients. 

It will be seen from the superintendent's report that steady 
progress has been made in improving the medical care of pa- 
tients, and soon it should be on a par with that in the best State 
hospitals. An important factor in this improvement is the in- 
crease in occupation. The July report of the superintendent 
states that in 1909, during the month of June, 136 men and 
129 women were employed, whereas in the corresponding month 
in 1910 there were 186 men and 253 women. It is satisfactory 
to know that among the outdoor workers were demented, untidy 
and disturbed patients who hitherto had been idle in the wards. 
One especially valuable piece of work done by the outdoor work- 
ers was the filling in of the new road from the Butler building 
to Harvard Street, and excavating for the addition. This was 
quite a large undertaking, and was a saving to the State as 
well as a benefit to the patients. As the superintendent gives 
a detailed statement of the kinds of occupation, nothing need 
be said here on the subject. The trustees hope to continue to 
find congenial employment for patients, until all who are able 
have something to do. 



1910.] PUBLIC DOCUMENT — No. 84. 



11 



Repairs and Improvements. 

The year has been a busy one in this department as appears 
from the superintendent's report. Much outside and inside 
painting and mason and carpentering work have been done> 
Special attention has been paid to the barns, basements, cor- 
ridors and out-of-the-way places, which were sadly in need of 
renovating. The solarium and laboratory, both valuable im- 
provements, were completed at small expense by the hospital 
mechanics. The appearance of the grounds has been much im- 
proved by clearing up the Callahan property, from which old 
buildings, walls and fences have been removed. 

While a good deal has been accomplished, much remains to 
be done before the trustees will feel that the hospital is in 
first-rate condition. The barns, stables and piggery are all old 
and unfit for use, and should be pulled down and replaced by 
others. The plumbing in many wards is worn out, and so un- 
sanitary that it should be removed. 

The wards would be much pleasanter to live in if they could 
be fitted up with enough furniture to make them homelike. It 
will take a liberal expenditure each year for several years, but 
as much as possible should be done if we wish to accomplish 
the best results, both from the medical and the humanitarian 
points of view. 

Appropriations for 1911. 

The maintenance appropriation asked for this year is $223,- 
600, or an increase of $10,050 over last year. This increase is 
mainly accounted for by the increased compensation and shorter 
hours of nurses, salaries and wages for a larger medical and 
general staff, temporary care cases, and the cost of board of a 
larger number of patients. 

To carry out the plans of the trustees for the further growth 
of the hospital, the following special appropriations are respect- 
fully asked for: in visiting the buildings in the men's depart- 
ment legislative committees have very justly criticised the large 
amount of unnecessary space taken up by halls and passage- 
ways, and also the cheerlessness of them. Plans have been 



12 



BOSTON STATE HOSPITAL. [Dec. 



prepared for throwing some of these halls into the wards and 
taking down partition walls, in this way giving more light 
and enough extra space to accommodate about 32 patients. For 
this purpose the trustees ask for the sum of $6,000. 

At present we have no proper quarters for male nurses, and 
this lack is one of the reasons why it is hard to retain good 
men in our employ. With the continually increasing number 
of patients, our present accommodations, poor as they are, are 
becoming overcrowded. We therefore ask for an appropria- 
tion of $22,000 to provide a nurses' home for 35 men. 

For a portion of a group of farm buildings, to comprise two 
dormitory buildings and a central service building, we ask an 
appropriation of $83,000. The central service building will 
provide for the future needs of the entire group. At present 
we are hardly doing all that we should for our patients em- 
ployed on the farm. They should live near their work, and be 
allowed liberty and privileges not possible for other and sicker 
patients. It will be of distinct advantage to have them in a 
group, and easily accessible to the farm and barns. 

For a service building for the entire institution, including a 
bakery plant, we ask an appropriation of $42,000. So far the 
hospital has had only a few small refrigerators and no store- 
room of adequate size. Consequently provisions cannot be kept 
in quantity, and only a limited stock of general supplies. 
Within a comparatively short time we shall have a population of 
upwards of 1,200. The economical administration of an insti- 
tution caring for so many patients requires a thoroughly 
equipped service building, including a refrigerating plant. 

When the infirmary buildings are completed an addition to 
the electric light and power plant will be needed. We ask $13,- 
875 for this purpose. 

Summary of Appropriations for 1911. 



Maintenance, $223,600 

Special appropriations: — 

Alterations, buildings men's department, 6,000 

Nurses' home, 22,000 

Farm group, 83,000 

Service building, 42,000 

Addition to electric light and power plant, 13,875 



1910.] PUBLIC DOCUMENT — No. 84. 



13 



Resignation of a Member of the Board. 

On Oct. 19, 1910, the chairman received notification from 
Mr. Koshland that he had tendered his resignation to the Gov- 
ernor as a trustee. At the November meeting of the Board the 
following resolution was unanimously adopted : — 

Resolved, That the secretary be directed to communicate to Mr. Joseph 
Koshland their very deep regret at his withdrawal from the Board, and 
their high appreciation of his valued services as a trustee. 

Resignation of Superintendent — Appointment of Super- 
intendent AND Director. 

In February Dr. Copp resigned, finding it impossible to act 
as superintendent and at the same time perform his duties as 
executive officer of the State Board of Insanity. At a special 
meeting in March the Board voted to accept his resignation as 
superintendent, to take effect April 15, and it also voted " that 
the Board express to Dr. Copp its grateful appreciation of his 
very valuable and successful service in the interest of the hos- 
pital." At the same meeting, Dr. Henry P. Frost, first assist- 
ant physician of the Buffalo State Hospital, was elected 
superintendent, the appointment to take effect April 15. Dr. 
Frost had been for twenty years in the service of the State of 
'New York, first at Willard, and later, for thirteen years, at 
Buffalo, and his recommendations were of the highest character. 
The trustees are glad to say that he has fully realized their 
anticipations of his medical and administrative ability. 

Recognizing the importance of having a man of the highest 
attainments to take charge of the medical and scientific work of 
the psychopathic hospital, the trustees gave careful and pro- 
longed consideration to the matter. As a result they tendered 
the appointment to Dr. Elmer E. Southard, professor of neuro- 
pathology in the Medical School of Harvard University, and 
pathologist to the State Board of Insanity. Dr. Southard has 
accepted the appointment under the title of director, and will 
enter on his duties when called on. In the meantime he has 



14 BOSTON STATE HOSPITAL. [Dec. 



given valuable advice as to the arrangement and equipping of 
the laboratories. 

The reports of the superintendent and treasurer are ap- 
pended. 

Respectfullj submitted, 

WALTER CHATs^NI^sTG. 
HEITRY LEFAVOUR. 
HEIvTKIETTA LOWELL. 
KATHERINE G. DEVI:N"E. 
MICHAEL J. JORDAN". 
WILLIAM TAGGARD PIPER. 



1910.] PUBLIC DOCUMENT — No 84. 



15 



SUPERINTENDENT'S REPORT. 



To the Trustees of the Boston State Hospital. 

The annual report of the superintendent is respectfully sub- 
mitted for the year ending l^ov. 30, 1910, together with the 
statistics prescribed by the State Board of Insanity, which are 
for the year ending September 30. 

There were 790 patients in the hospital at the beginning of 
the statistical year ; the admissions numbered 597, the dismissals 
371, deaths 155, leaving 861 at the close of the year. 

The daily average number of patients was 816.41, of whom 
694.40 were State charges, 39.59 reimbursing and 82.42 private; 
1,323 different patients were in the hospital during the year. 

There were 49 emergency, 10 voluntary and 165 temporary 
care cases; of the last mentioned, 55 were committed to this 
hospital, 54 committed to or returned to other hospitals, 46 
were discharged without commitment, and 10 remained in the 
observation ward at the end of the period. 

Exclusive of temporary care cases, transfers and returns from 
visit, 407 patients were received, of whom 350 were admitted 
for the first time, 36 for the second time and 21 for the third 
to ninth time. 

The cases never before committed to any hospital for the in- 
sane numbered 330, of whom 166, or 50.3 per cent., were foreign 
born, and 263, or 79.6 per cent., were of foreign parentage on 
one or both sides. 

The average age on admission of cases first admitted to any 
hospital was 46.17 years; 22.4 per cent, were 60 years of age 
or more. 

The chief causes of insanity were senility in 15.4 per cent., 
alcoholic excesses in 10.6 per cent., and syphilis, apoplexy, ar- 
teriosclerosis and other organic conditions affecting the nervous 
system in 8.7 per cent. ; 3 per cent, had congenital mental defect. 



16 



BOSTON STATE HOSPITAL. [Dec. 



The duration of mental disease before admission to the hos- 
pital averaged 13.8 months; it was less than 6 months in 48.1 
per cent. 

IsTot more than 33.3 per cent, of cases first admitted were 
suffering from curable forms, such as manic-depressive insanity, 
toxic and exhaustion psychoses, etc.; 10.3 per cent, were cases 
of general paralysis. 

The discharges, exclusive of transfers, numbered 237, of 
whom 65 were recoveries, being 10.9 per cent, of the admissions. 
If the temporary care cases be excluded, the discharges num- 
bered 140, of whom 43 were recoveries, — 10.5 per cent, of 
commitments. On the same basis, 18 were discharged as capable 
of self-support and 53 as improved. Undoubtedly these figures 
are too low to represent the actual recovery rate, owing to the 
frequent failure to ascertain the condition of discharged patients 
at the end of the six months' trial period, an omission which it 
is now sought to supply by requiring them to return to the 
hospital for final examination, or to furnish otherwise satis- 
factory information on this point. 

There were 155 deaths, 2 of which were in the temporary 
care service ; excluding these, and figuring on the committed 
cases only, the deaths were 12.5 per cent, of the whole number 
of patients under treatment. This is an increasing percentage, 
due to the fact that we receive so large a proportion of the aged 
and feeble, and do not include this class in the periodical trans- 
fers which are made to asylums. Eighty-five, or 55.5 per cent., 
of those who died were over sixty years of age, and 21 were over 
eighty. 

Death resulted from tuberculosis in 7 cases, from cerebral 
apoplexy in 11, from general paralysis in 35. Two of the 
deaths were suicides ; 1 was from accidental injury and 1 from 
asphyxiation with food. 

The hospital is caring for more patients than heretofore, not- 
withstanding its capacity is reduced by giving up the Butler 
building to the temporary care service, and using the farmhouse 
for employees instead of for patients' quarters. This has been 
made possible during the summer and fall by lodging 30 men 
patients in tents, and 9 women, cases of tuberculosis, in a can- 
vas pavilion adjoining the infirmary ward. The patients who 



1910.] 



PUBLIC DOCUMENT — No. 84. 



17 



had the fresh-air treatment were so greatly benefited by it, and 
were so comfortable and Satisfied withal, that we are hoping to 
continue it next year on a larger scale. 

The general health has been good throughout the year until 
October, when an outbreak of typhoid, or rather paratyphoid, 
fever occurred at the women's department, involving principally 
the nurses, but including among its victims to date the chief 
engineer, Mr. Morse, 2 cooks, the baker, a laundress, 2 porters 
and 2 male patients who were employed in the kitchen, — a 
total of 27 cases. Fortunately, no deaths have occurred, and at 
the present time most of the sick are convalescing. Owing to 
our lack of hospital accommodations for so many, 9 of the pa- 
tients (nurses and other employees) v/ere treated at the City 
Hospital. Through the kindness of Dr. Lesley H. Spooner of 
the Massachusetts General Hospital staff, who supplied the 
serum and demonstrated the method of administration, anti- 
typhoid inoculation was practiced on 48 of the officers and em- 
ployees. If the epidemic is at an end, as appears to be the case 
now, it is presumable that this measure contributed to prevent 
its further spread. 

With the co-operation of the State and city boards of health 
a thorough investigation was made, which showed that the dis- 
ease was not due to infection through any article of food or 
drink, but that it probably spread by contact from a " walking " 
case, contracted outside the institution. The opportunity was 
utilized for the prosecution of research work on the epidemi- 
ology of typhoid and paratyphoid and laboratory study of cul- 
tures from the blood and dejecta. For collaboration with Dr. 
Canavan in this work we are indebted to Dr. E. T. F. Eichards 
of the Harvard Medical School, as well as to Dr. Southard, 
pathologist to the State Board of Insanity, who gave valuable 
advice and helped to shape the inquiry. 

In this connection it is gratifying to record that the research 
on diphtheria, authorized by the Board last year, has reached a 
stage where Dr. Morse, who has it in charge, thinks she can 
predict important practical results in the shape of a new diag- 
nostic aid to distinguish true diphtheria from diphtheroid infec- 
tions. A preliminary note by Dr. Morse will appear as an 
appendix with this report. 



18 



BOSTON STATE HOSPITAL. [Dec. 



Fatalities. 

Two deaths by suicide and 2 from accident have to be re- 
ported. A woman patient, sixty-one years of age, suffering 
from melancholia, hanged herself with a towel in her room, on 
December 16, ten days after her admission to the hospital. A 
female epileptic died July 11 from asphyxiation, caused by 
the occurrence of a convulsion at the meal hour, food being 
drawn into the larynx. A patient in the men's department 
ran from the w^alking party and threw himself under a loaded 
wagon which was passing on the street, and was killed by a 
wheel crushing his neck. This occurred on September 13. 

In the men's department a patient met his death, September 
8, under circumstances which required and received a most 
rigid investigation, It was shown in an inquiry before the 
grand jury that he had made a violent assault upon an attend- 
ant, and a struggle ensued, both falling to the floor. The pa- 
tient died in collapse a few hours later, and an autopsy by the 
medical examiner disclosed as the cause of death rupture of the 
inferior vena cava. Inasmuch as the attendant acted in self- 
defence, and exhibited a black eye and numerous abrasions on 
his face, while the patient's body presented externally only 
trifling marks of violence, the death was held to be due to un- 
avoidable accident, and a " no bill " was reported. The attend- 
ant was, however, changed from ward duty to a position not 
involving the care of patients. 

Tempoeary Caeei Sehvice. 

The last Legislature passed a measure (chapter 307, Acts of 
1910) which directed that suitable quarters be set apart at this 
hospital for the observation and temporary care, pending exam- 
ination and commitment, of persons suffering from mental dis- 
orders who should come under the care of the police in the city 
of Boston. In compliance with this direction the Butler build- 
ing, containing two wards, each with a capacity for 10 patients, 
was emptied by transfer of that number to other wards, and on 
May 1 was ready for the reception of these cases, — one ward 
for men and one for women. 

This wise and humane provision for immediate beginning of 



1910.] PUBLIC DOCUMENT — No. 84. 



19 



a portion of the service which the psychopathic hospital will 
render to the community has met an urgent need, and has been 
of incalculable benefit to a large number of sick persons who 
would otherwise have been, of necessity, confined in a police 
station or jail for a longer or shorter period, awaiting commit- 
ment and transfer. Under authority of the above enactment 
such patients are now brought directly to the hospital at any 
hour of the day or night, and receive at once the care and 
treatment their condition demands. With willing and intelli- 
gent co-operation on the part of the police department, this 
method has worked smoothly, and in only a few instances have 
we felt called upon to reject as unsuitable cases the patients 
who were presented. After an experience of seven months, 
covering the reception of nearly 200 cases, there can be no doubt 
that the prompt relief thus afforded operates to cut short in- 
cipient attacks, to moderate others and to shorten the period of 
treatment necessary in a large proportion, besides protecting 
the patients from needless suffering and distress. 

Some statistics of this service are included in Table 'No. 1, 
to be found elsewhere in this report, but a more satisfactory 
review of its operations for the seven months to December 1 
is presented in the following tabulation : — 





Males. 


Females. 


Totals. 


Admissions from May 1 to Dec. 1, 1910, 




115 


83 


198 


Chapter 504, Acts of 1909, section 34, 








1 


1 


Chapter 504, Acts of 1909, section 42, 






4 


4 


8 


Chapter 504, Acts of 1909. section 43, 






3 


3 


6 


Chapter 504, Acts of 1909, section 44, 






5 


11 


16 


Chapter 307, Acts of 1910, .... 






103 


64 


167 


Discharges from May 1 to Dec. 1, 1910, . 






113 


79 


192 


Recovered, 






22 


8 


30 


Improved 






5 


2 


7 








2 




2 


Died 








2 


2 


Not insane, 






3 


8 


11 


Deported, 






2 




2 


Committed to Boston State Hospital, 






31 


37 


68 


Committed to Dan vers State Hospital, . 






23 


10 


33 


Committed to Worcester State Hospital, 






6 


4 


10 


Committed to Westborou!?h State Hospital, . 






9 


4 


13 


Committed to Taunton State Hospital, . 






1 




2 


Committed to Monson State Hospital, . 






1 




1 


Committed to McLean Hospital, 






1 




1 


Committed to Butler Hospital, Providence, R. I., 










1 


Returned to Boston State Hospital, 










1 


Returned to Med field State Asylum, 






2 




2 


Returned to Worcester State Hospital, . 






2 


1 


3 


Returned to Westborough State Hospital, 






1 


1 


2 


Returned to Monson State Hospital, 








1 




Patients remaining Dec. 1, 1910 


2 


4 


6 



20 BOSTON STATE HOSPITAL. [Dec. 



Provisional Diagnosis in Temporary Care Cases. 





Males. 


Females. 


Totals. 


Admissions from May 1 to Dec. 1, 1910, .... 


115 


83 


198 




3 


3 


6 




20 


4 


24 


Cerebral thrombosis, 


- 


1 


1 




1 


_ 


1 


Alcoholic psychoses: — 






Pathological intoxication, 


1 


2 


3 




5 


2 


7 


Polyneuritic psychosis, 


1 


_ 


1 




20 


10 


30 


Chronic delusional, 


3 


_ 


3 


Chronic HlcoholLsm, 


1 


- 


1 


Drue and toxic psychoses: — 








Morpliinism, 


1 


- 


1 




1 


- 


1 




4 


2 


6 




21 


20 


41 


Paranoic conditions. 


3 


5 


g 


Manic-depressive psychosis: — 








Excitement 


13 


17 


30 




6 


4 


10 




2 




3 




3 


2 


5 




1 




1 




2 




2 




3 


9 


12 






1 


1 



Medical Service. 

The following changes have occurred in the personnel of the 
medical staff : — 

Dr. Samuel W. Crittenden was promoted to he assistant 
superintendent January 1. Dr. Stephen E. Yoshurgh was ap- 
pointed assistant physician April 1. Dr. Myrtelle M. Canavan 
was appointed pathologist October 1. Dr. Harry M. Nicholson 
was appointed junior assistant physician October 1. Dr. 
George H. Maxfield, first assistant phj'sician, resigned ^Tovem- 
ber 15 to accept the position of surgeon to the Soldiers' Home 
in Chelsea, a well-deserved promotion. Dr. Arthur B. Moul- 
ton, formerly of the Northampton State Hospital staff, has been 
secured for temporary service until the vacancy caused by Dr. 
Maxfield's resignation shall be filled. 

Regular staff meetings have been inaugurated for the presen- 
tation of cases for diagnosis, discussion of treatment, determina- 
tion of the question of discharge, etc. A systematic record of 
the proceedings is kept, which proves extremely useful, espe- 
cially in cases which are brought up for further discussion at a 
later meeting, as is -^-^ten done. 



1910.] PUBLIC DOCUMENT — No. 84. 



21 



The medical officers have had additional duties imposed upon 
them in consequence of the temporary care service, the inaug- 
uration of staff meetings, more extended case histories with 
preparation of abstracts for discussion of these, more 1-ectures 
to the training school, and, latterly, the care of the nurses and 
other employees ill with typhoid fever. The lack of a pharma- 
cist, too, makes necessary their performance of routine work 
which interferes with more important activities. The recent 
addition to the staff of a junior assistant physician has given 
needed assistance in the clinical work, and the opening of a 
well-equipped bacteriological and pathological laboratory to- 
ward the close of the year, with a skilled and enthusiastic 
worker in charge of this department, puts the medical work on 
a higher level, and, like the staff meetings, promotes keener 
interest and a progressive scientific spirit. That advantage is 
taken of the new facilities afforded by the laboratory is shown 
by the more frequent employment of diagnostic aids, such as 
blood examinations and lumbar puncture, also by the increased 
number of autopsies obtained ; of these there have been 12 dur- 
ing the year, 5 of them in the past two months. 

As a further aid to the medical staff, considerable additions 
have been made to the list of journals and reviews, and the med- 
ical library has had some needed accessions. 

The services of a dentist. Dr. Howard A. Lane, have been 
secured for one forenoon each week, and this very essential part 
of the care and treatment of the patients is being well at- 
tended to. 

^N'uRsiwG Service. 
During the year an important measure discussed in the pre- 
vious annual report — shortening the hoiirs of duty — was put 
into effect, and, though the change entails an added expense of 
several thousands of dollars a year, the cost is more than repaid 
by the increased efficiency and the better spirit it has engendered 
in the corps. Each attendant and nurse under the existing ar- 
rangement has one full day off duty each week, and in addi- 
tion has hours off daily, reducing the actual time on duty to 
sixty hours a week. If we can now supply these employees, 
upon whose capacity and devotion to duty the welfare of the 



22 BOSTON STATE HOSPITAL. (Dec. 



patients so directly depends, with more comfortable living 
quarters, well separated from the wards, all necessary require- 
ments for the maintenance of a stable, efficient and loyal nurs- 
ing force will have been met. 

Traixin-g School. 

The training school for nurses remains under the same effi- 
cient management as for some years past, and continues its 
important work with gTatifying success. Some additions have 
been made to the curriculum and more definition given the 
schedule of work and study, but the most important change to 
be recorded is the extension of its privileges to the men attend- 
ants, several of whom have been induced to undertake the course. 
This very desirable extension of the school's usefulness was 
made possible, I think, by the gTadual introduction of women 
nurses in the vrards for male patients, where their influence 
prevails to stimulate the nursing spirit and give new interest 
to what is, under routine conditions, apt to be considered by 
the men as mere drudgery. 

Another thing which has, I am sure, bettered the service in 
the men's department is the setting apart of a small ward for 
the reception and special care of new admissions. 'Not only has 
this made it possible to give the acute cases better attention, 
it has emphasized to the attendants the importance of the hos- 
pital feature, and demonstrated the need of special training, 
for which an awakened interest creates desire. 

A special course of training has been instituted which is 
obligatory for those attendants who do not care to take the full 
course in the training school. This consists of a series of lec- 
tures and demonstrations covering the essentials of nursing, 
and in particular the care of the insane, with systematic in- 
struction in practical duties in the wards. 

Occupation of Patients. 
An earnest effort has been made to provide a variety of use- 
ful and stimulating occupation for the patients. A large party 
of men from the wards for the demented and untidy and dis- 
turbed classes has been engaged all the season in excavating. 



1910.] PUBLIC DOCUMENT — No. 84. 



23 



grading, digging ditches, laying drain pipe, repairing roads, 
etc., accomplishing a creditable amount of work, and under- 
going themselves an improvement in health, habits and mental 
condition which was very notable in some and sufficient to be 
gratifying in practically all. The farmer has had more pa- 
tients for his work, and all other working departments have 
been kept well supplied. An upholsterer was employed and in- 
stalled as shop foreman to develop a line of industries having 
as its nucleus mattress making, which has heretofore been con- 
ducted on a smaller scale. He has taught 3 patients to make 
mattresses; 6 or 8 prepare the hair; 1 repairs shoes; another 
helps to make cushions, cut and fit curtains, etc. It is hoped 
that we can now add to these activities broom and mat making, 
and then other industries as rapidly as they can be gotten 
under way. In the women's department the force of seam- 
stresses has been augmented both in the sewing room and in 
the wards, and in addition an industrial room is filled with pa- 
tients engaged in fancy work, basketry, making artificial flow- 
ers, etc., — employments which give them pleasure and afford 
mental stimulation of decided therapeutic value. Many of the 
women, too. had healthful outdoor work during the summer, as 
in previous years, gathering the fruits and vegetables daily 
from the garden. 



En^teetainment of Patients. 

In addition to the fortnightly dances from October to May, 
and occasional entertainments in the chapel, principally con- 
certs, the women patients have enjoyed several picnics and a 
number of tea parties, card parties, ward musicales, etc., sleigh 
rides during the winter, and, during the summer, carriage and 
automobile rides. 

The patients, both men and women, were assembled for a 
Christmas entertainment, consisting of a musical program, 
gaily decorated tree and a distribution of presents, provided in 
part by their friends and in part by the hospital. 

On July 4 a band concert was given at each department, 
which was greatly enjoyed by the entire population. A graph- 
ophone was purchased and is kept in circulation, enlivening 



24 



BOSTON STATE HOSPITAL. [Dec. 



each ward in turn. The men make constant use of three pool 
tables, and many devote themselves to cards and other games. 
More than one hundred books have been added to the patients' 
library, and a number of old volumes have been rebound. A 
generous list of magazines and illustrated weeklies is subscribed 
for, and these are distributed throughout the wards. A smok- 
ing and recreation room for patients is being fitted up in the 
basement of the men's department. 

Thanksgiving was, as usual, observed with an appropriate 
feast. 

Repairs and Improvements. 

Painting has gone steadily forward. At the women's de- 
partment the C and E buildings were painted outside and 
inside, the bakery and kitchen inside, the sewing room and the 
front and back corridors, the office entrance, a corridor in Ward 
B and the laboratory. At the men's department the interior of 
the wards was completed, with the exception of Ward 5 rear, 
and the center corridor and, general dining room, the connect- 
ing corridors to the wards, the kitchen and the attendants' and 
other employees' quarters in the third stories were painted, 
besides painting and whitewashing in the basements and some 
work in the farmhouse. At the barn the milk room received 
attention. The superintendent's house was painted outside 
and some interior work was done. 

The wooden walk to Austin Street was relaid, largely with 
new material ; a fence was built around the pond as a protection 
against patients jumping in; window openings were enlarged 
and two cement areas built to provide better light for the lab- 
oratory in the Stedman basement; tables and shelving were 
made and installed in these rooms and gas introduced from 
Harvard Street; the old barns were repaired; a shelter house 
for fire hose was constructed ; additional bathtub, closet and 
washbowls put in nurses' quarters in E attic ; a bath room was 
equipped at the farmhouse and hot-water heater installed in 
the basement; a new hot-water heater was put in the super- 
intendent's house and the porch there was rebuilt. 

A separate dining room for the men attendants was provided 
by structural alterations in quarters adjoining the patients' 



1910.] PUBLIC DOCUMENT — No. 84. 



25 



dining room, a serving room for the officers' table was similarly 
contrived out of a storeroom, and the main serving room was 
improved with new cupboards and sink. In the kitchen at the 
men's department the floor drains were cleaned out, lined with 
cement and covered with iron plates, and the discharge pipes 
from the sink and other fixtures were suspended in them by 
rod hangers, remedying a very unsanitary condition there. 

The engineer has continued the work of shortening and 
straightening returns and insulating pipes, effecting thereby a 
saving of several thousand dollars in the cost of coal for the 
year; and in addition his force has attended to many ordinary 
repairs, as have the other departments. 

The ISTew England Telephone and Telegraph Company in- 
stalled a private branch exchange in the women's department, 
connecting with the men's department over a line of poles 
erected and owned by the hospital. This adds greatly to the 
ease and promptness of intercommunication, and facilitates 
the business of all who have occasion to telephone to the hospital. 
A better system of house phones is badly needed in both depart- 
ments and should be provided next year.. 

Farm and Grounds. 

Excellent crops were obtained notwithstanding the dry sea- 
son. The tables were abundantly supplied with vegetables, and 
we have stored 3,000 bushels of potatoes, besides quantities of 
turnips, beets, carrots, squash, pumpkins, cabbage and celery; 
also 200 tons of hay and 190 tons of ensilage for the stock. 

The herd of cows was tested for tuberculosis by thf State Cat- 
tle Bureau, and eleven animals found to be diseased were con- 
demned and slaughtered. The cow stable was then thoroughly 
disinfected and whitewashed throughout; it is practically unfit 
for further use, however, and plans should be made for a new 
one as soon as possible. 

A power sprayer was bought and energetic woik continued 
against the gypsy and brown-tail moths, with excellent results, 
I our trees showing little evidence of their activity -at any time 
during the season. The expense of this item for the year, in- 
cluding the sprayer, did not exceed the sum spent the previous 



26 



BOSTON STATE HOSPITAL. 



[Dec. 



year, when it was done by a contractor; and next year it will, 
of course, be mncli less. Much has been done to improve the 
appearance of the grounds. The old house and barns on the 
Callahan property, acquired last year, were torn down, the 
whole lot cleaned up and put' under cultivation, and a dilapi- 
dated stone wall separating it from the hospital lawn removed. 
Several lines of farm fencing should be put up next year, and 
a beginning, at least, should be made on a suitable boundary 
wall or fence, for which a design has been adopted by the Board. 
This it is expected can be done by our regular mason at a very 
moderate cost, suitable stone being at hand. 

The sewer division of the city street department is complet- 
ing the work begun last year of deepening and widening the 
brook channel through the hospital property, which will render 
possible the effective drainage of our lowland and bring a large 
area of marsh under cultivation. The farmer has men and 
teams at work now clearing this land and laying drains. 

Maintenance Expenses. 

The amount expended for maintenance was $213,544.77, 
which, divided by the daily average number of patients, 827.93, 
makes the weekly per capita cost $4,946. Receipts for board 
of private patients were $18,896.21; from reimbursing pa- 
tients, $6,574.23; from sales and other sources, $2,246.59, 
making the total income $27,717.03. 

Deducting receipts from gross expenses, the net cost of 
maintenance was $185,827.74, which, divided by the above aver- 
age number of patients, gives a net weekly per capita cost of 
$4,302. 

The gross expenses exceeded those of the previous year by 
$21,564.02, which was in accordance with the estimates, and 
for which an explanation was furnished in last year's report. 

For the coming year the expense of maintenance is estimated 
at $223,600. This is an increase of $10,050, which is due to 
the folio vving causes: 26 more patients to be cared for; addi- 
tional officers and employees, to meet the greater demands of 
improved service under conditions of shorter working hours; 
the temporary care service, pending completion of the psycho- 



1910.] 



PUBLIC DOCUMENT — No. 84. 



27 



pathic hospital; maintenance of the sixty-hour-a-week schedule 
for employees a full year instead of six to eight months, the 
period for which it was in operation the current year. 

Alterationsi, Additional Buildijstgs and Equipment. 

One of the earliest recommendations made by the Board of 
Trustees related to the need of certain structural alterations 
in the ward buildings at the men's department, to utilize waste 
space and convert gloomy and ill-ventilated sections into cheer- 
ful, well-lighted quarters for patients. This can easily be done, 
and while providing additional accommodations at a very low 
per capita cost, the appearance of the wards will be greatly im- 
proved. 

In order to do away with the expense of maintaining two 
electric light and power plants, and to provide for the extension 
of lighting current to projected new buildings, it is considered 
essential that a change be made eventually from the direct cur- 
rent to the alternating system. As a step in that direction, and 
as the wisest measure to provide for immediate needs, a plan 
is presented for the installation of two alternating current gen- 
erators and a small motor generator set, with the necessary 
transformers and wire connections. This has been worked out, 
with your approval, after careful consideration, and on the 
advice of competent engineers who have studied our problem. 

The present bakery will be totally inadequate to supply the 
institution when increased by the completion of the infirmary 
group and the psychopathic hospital, now under construction. 
Our facilities for cold storage of food stuffs are practically 
nil; the ice from the pond is unfit for use in drinking water; 
we have cramped and inconvenient quarters for general stores 
in the basement of an old wooden building which should soon 
be torn down to give place to a modern ward building. To pro- 
vide these needs your directions have been followed in the 
preparation of plans for a service building to contain a bakery, 
a cold-storage and ice-making plant, and general stores, with 
basement bins for the storage of vegetables. 

A home for men attendants is a most urgent need which has 
already been referred to. The projected farmstead group 



28 



BOSTON STATE HOSPITAL. [Dec. 



should be begun bj the erection of two dormitories and a service 
building, the latter to contain the patients' baths, sitting room 
and dining room, together with dining room and sleeping quar- 
ters for employees. 

It is regretted that plans for a new cow barn, which is badly 
needed, could not be prepared in time for presentation this 
year. 

Your Board has approved plans, specifications and estimates 
for the above items, and these have been presented to the Au- 
ditor of the Commonwealth for submission to the Governor and 
Council and to the Legislature, with your petition for appro- 
priations as follows : — 

Alterations in south dormitory building, men's department, . $6,000 



Home for male attendants and nurses, 22,000 

Farm group, comprising central service building, two dormi- 
tory buildings and heating plant, 83,000 

Service building, comprising general stores, cold storage and 

bakery, 42,000 

Addition to electric light and power plant, 13,875 



Total, : . . $166,875 



Grateful acknowledgment is made of the kindness of friends 
who have donated their services for the entertainment of pa- 
tients; namely, to Dr. Dixwell and his associates of the Hos- 
pital Music Association and to the Dorchester Woman's Club; 
also to our officers and employees who have exerted their 
talents to the same end. Magazines and other reading matter 
for the wards, most acceptable gifts, have been received through 
the kindness of Mr. and Mrs. Frank F. Stone, Dr. Walter Chan- 
ning and the Hospital Newspaper Society. Eeligious services 
have been regularly conducted by Kev. Father McCafferty and 
Rev. Charles S. Otto, to whom our thanks are due for their 
ministrations. 

For myself, I cannot express the gratitude I feel for the 
loyal co-operation of the officers and employees, whose faithful 
performance of duty and cheerful spirit have at all times 



1910.] PUBLIC DOCUMENT — No. 84. 



29 



lightened the load of administration and helped in overcoming 
difficulties ; while to you I am indebted for ready appreciation 
of my efforts and uniform support and encouragement, as well 
as for wise counsel and direction. 



EespectfuUy submitted, 

HEJSTEY P. FEOST, 

Superintendent. 

Nov. 30. 1910. 



30 



BOSTON STATE HOSPITAL. [Dec. 



REPORT OF THE DIPHTHERIA INVESTIGA- 
TION FOR THE BOSTON STATE 
HOSPITAL. 



The diplitheria epidemic at the Boston State Hospital during 
the spring and summer of 1909 suggested several lines of work 
upon bacillus diphtherise and diphtheroid organisms. The in- 
vestigation, which was undertaken at the instance of Dr. E. E. 
Southard, has been pursued intermittently from July, 1909, to 
the present time. Its scope has enlarged as interesting and im- 
portant problems have suggested themselves in the course of the 
work. 

The main problem at the present time is the study of the 
group of diphtheria bacilli by the biometrical or statistical 
method. This method, which, briefly stated, involves the com- 
parative study of a large number of cultures, has recently been 
applied with great success to the coccacese,^ and has enabled a 
natural classification of the numerous members of this family 
to be made. It is expected that this method will prove of equal 
value when applied to the diphtheria bacillus to determine 
whether or not divisions or subfamilies exist within the group, 
and also the relationship, so called, of the " pseudo-diphtheria " 
and " diphtheroid bacilli to the true Klebs-Loeffler organism. 
The latter question, which is one of the perennial discussions 
in bacteriology, can be decided with certainty by this method. 

One hundred and twenty-one strains of diphtheria and diph- 
theroid bacilli have been studied. These have been obtained 
from the Boston State Hospital, the Danvers Hospital and from 
other sources, through the courtesy of various individuals, | 
among whom may be especially mentioned Dr. B. L. Arms and 
Miss E. Marion Wade of the bacteriological laboratory of the 
Boston Board of Health. i 



* "The Systematic Relationship of the Coccacese," by C. E, A. Winslow and Ann Rogers 
Winalow, 1908. 



1910.] 



PUBLIC DOCUMENT — No. 84. 



31 



The plan of work has been to determine what are the char- 
acteristics of most value in the identification of the diphtheria 
bacillus, and then to study the selected characteristics by exact 
and comparable methods in a long series of cultures. 

The tests which have been found most suitable, and to which 
each strain has been, or is to be, subjected, are : — 

(1) Morphology, including the development of involution 
forms and of Neisser's granules.. The peculiarities of shape 
and the early development of polar granules and involution 
forms are very distinctive features of the true diphtheria bacil- 
lus, which, however, may be more or less closely imitated by 
the pseudo-diphtheria and diphtheroid organisms. 

(2) Vigor of growth and longevity of the organisms in cul- 
tures. The more strictly parasitic an organism the scantier is 
its growth, as a rule, and the shorter its life in cultures. 

(3) Chromogenesis. Many diphtheroids and some true diph- 
theria bacilli form pigment. 

(4) Virulence, determined by inoculation into guinea pigs. 
The Klebs-Loeffler bacillus, when freshly isolated from clini- 
cal cases of diphtheria, usually proves virulent (i.e., kills the 
guinea pig within three days when injected in suitable doses), 
but numerous nonvirulent strains also exist. The diphtheroids 
are almost without exception nonvirulent. 

(5) The quantitative determination, by titration, of acid- 
production by these organisms in dextrose, lactose, mannite, 
saccharose and dextrin broth. Of these, only dextrose and sac- 
charose have given uniform results ; the reactions with the other 
carbohydrates are too variable to be of value. It may be ad- 
visable later to try the fermentative powers with other sub- 
stances. 

(6) Toxin production. The formation of a toxin capable 
of being neutralized by diphtheria antitoxin is par excellence 
a distinctive characteristic of the true Klebs-Loeffler bacillus, 
separating it from superficially similar organisms. The testing 
of each organism for toxin production is, however, very labo- 
rious and expensive, involving, as it does, animal experimenta- 
tion in each case. In a number of trials which we have made 
we have found no toxin formation by pseudos or diphtheroids. 

(7) Serum reactions. These are considered by some inves- 



32 



BOSTON STATE HOSPITAL. [Dec. 



tigators to be the most delicate of all means of determJning the 
relationship of bacteria. In this work only agglutination has 
been tried up to the present time, but it is planned to test later the 
fixation of complement and the con-agglutination reaction. The 
results of the agglutination tests have been quite satisfactory, 
in spite of technical difficulties in getting homogeneous suspen- 
sions of diphtheria bacilli. True diphtheria bacilli have given 
positive reactions (by the macroscopic method) in high dilu- 
tions (/42oo) of serum from a rabbit immunized against B. 
diphtherise, while pseudo and diphtheroid organisms show no 
clumping, even in low dilutions. It is possible that the agglu- 
tination test with anti-diphtheritic serum may prove to be a 
diagnostic procedure of some importance by furnishing a quick 
and easy way of distinguishing the true IHebs-Loeffler bacillus. 

The data already accumulated have been analyzed statistically 
and the results plotted. The organisms seem already to be 
grouping themselves, but the number of strains thus far inves- 
tigated is so small that it would be premature to announce re- 
sults at this time. 

Recently, as a side issue, some work has been started, at the 
suggestion of Dr. Walter R. Brinckerhoff of the Harvard Medi- 
cal School, on the restoration of virulence of cultures of B. 
diphtherise, which have spontaneously become attenuated, by 
growing them with amebEe. 

It was hoped during this work to investigate a diphtheroid 
organism called by Ford Robertson of Edinburgh B. paralyt- 
icans, and claimed by him to be of importance in the etiology 
of general paresis. As yet no opportunity to do this has pre- 
sented itself, but the question of diphtheroid organisms in gen- 
eral in insane hospitals is a matter of importance and should * 
be investigated. 

During the coming winter it is hoped to continue the work 
by adding to the number of strains studied in the routine man- 
ner, and especially to investigate the immunity reactions of the 
group. It is expected that by the end of another six months 
results of value may be ready to publish. 

M. E. MORSE. 



New England Hospital for Women and Children, Nov. 30, 1910. 



1910 ] PUBLIC DOCUMENT — Xo. 84. 33 



SUPERINTENDENT OF NURSES' REPORT^ 



To the Superintendent of the Boston State Hospital. 

The eleventh annual report of the Training School for 
Nurses is herewith respectfully submitted : — 



Christine A. Johnston. 
Jessie G. Bruce. 



Graduating Class of 1910. 

Ellen B. McMuUin. 
Mary B. MacDonald. 



Nursing Staff. 

Superintendent of nurses, 1 

Assistant superintendent of nurses (graduate); 1 

Supervisors, day (graduates), 3 

Supervisor, night (graduate), 1 

Head nurses (graduates), 5 

Head nurses (pupils), 8 

Night nurses (pupils), 8 

Night nurses (attendants), 5 

Pupils, day, 22 

Probationers, 10 

Attendants, 17 

AppHcations during the j^ear, 353 

Apphcations accepted, 86 

Probationers accepted, 23 

Pupils left, 7 

Probationers rejected, 24 



The training school has graduated 4 nurses during the year, 
making a total of 68 nurses since it was organized. Seventeen 
of our graduates have resigned during the year, 11 of whom 
have entered a general hospital for a post-graduate course, 5 
are doing private nursing and 1 resigned on accoimt of ill 
health. 

Owing to the change to ten-hour service on the wards, we 



34 BOSTON STATE HOSPITAL. [Dec. 

were obliged to increase the number on our nursing staff con- 
siderably. The epidemic of typhoid fever among the nurses 
has necessitated a further addition to the staff for the present. 

The training school opened this year with a larger attendance 
than at any previous season, which is shown as follows (this in- 
cludes 7 men from the men's department) : — 

Senior class, 7 

Intermediate class, 10 

Junior class, 23 

Probationers, 16 

Instruction is given by the physicians of the hospital staff, 
the superintendent and the assistant superintendent of nurses, 
covering courses in anatomy, physiology, hygiene, bacteriology, 
materia medica, urinalysis, hydrotherapy, housekeeping, die- 
tetics and cooking, general nursing, obstetrical nursing, and 
especially nursing of nervous and mental diseases. 

Eespectfully submitted. 



JANE EOBEETSO^s^, 

Superintendent of Nurses. 



1910.] 



PUBLIC DOCUMENT — No. 84. 



35 



VALUATION. 

Nov. 30, 1910. 



Buildings and 153 acres land taken from 



the city of Boston Dec. 1, 1908, . . $1,000,000 00 
79 acres land taken Oct. 1, 1909, assessed 



for, . 


62,710 


00 


22^0" acres land purchased Nov. 3, 1909, 






for psychopathic hospital, .... 


7o,yiy 


on 


Amount paid on new buildings and additions: 








14,726 


98 


Laundry, 


6,139 


42 


Butler, 


4,211 


73 


Provisions and groceries, .... 


$4,391 


72 


Clothing and clothing materials, 


10,711 


83 


Furnishings, 


47,514 


05 


Heat, light and power: — 






Fuel, 


1,680 


48 


Repairs and improvements : — 






Machinery and mechanical fixtures. 


20,620 


00 


All other property, 


4,773 


34 


Farm, stable and grounds: — 






Live stock on farm, .... 


8,078 


60 


Produce of farm on hand, 


7,865 


05 


Carriages and agricultural implements. 


4,586 


15 


All other property, 


1,868 


74 


Miscellaneous, 


2,412 


32 



$1,163,707 33 



112,502 28 



$1,276,209 61 



36 



BOSTOxN STATE HOSPITAL. 



[Dec. 



TREASURER'S REPORT. 



To the Trustees of the Boston State Hospital. 

I respectfully submit the following report of the finances 
of this institution for the fiscal year ending Xovember 30, 
1910: — 

Cash Account. 

Balance Dec. 1, 1909, . .. $982 79 



Institution Receipts. 
Board of inmates: — 
Private, 

Reimbursements, 

Salaries, wages and labor: 
Wages not called for. 



Receipts. 



$18,896 21 
6,574 23 



$25,470 44 



4 93 



Sales: — 
Food, 

Clothing and materials, 

Furnishings, 

Heat, light and power, 

Repairs and improvements, 

Miscellaneous, 

Farm, stable and grounds: — 
Cows and calves, . 
Pigs and hogs, 
Hides, 
Sundries, 

Miscellaneous receipts: — 

Interest on bank balances. 
Rent, 

Sundries, . . . 



$775 30 
65 45 
27 36 

1 05 
88 71 

3 19 



$532 69 
334 78 
17 50 
7 79 



$169 75 
177 00 
41 09 



Receipts from Treasury of Commonwealth. 
Maintenance appropriations: — 

Balance of 1909 

Advance money (amount on hand November 

30), 

Approved schedules of 1910, 

Special appropriations, ..... 



961 06 



892 76 



387 84 



$7,666 41 

15,000 00 
191,340 52 



27,717 03 



214,006 93 
34,498 73 



Total, 



$277,205 48 



1910.] 



PUBLIC DOCUMENT — No. 84. 



37 



Payments. 

To treasury of Commonwealth, institution receipts, $27,717 03 

Maintenance appropriations: — 

Balance November schedule, 1909, . . 8,649 20 

Eleven months' schedules, 1910, . . . 191,340 52 

November advances, ..... 11,091 52 



S238,798 27 

Special appropriations: — 

Approved schedules, 34,498 73 

Balance Nov. 30, 1910: — 

In bank, $3,524 67 

In office, 383 81 



3,908 48 



Total $277,205 48 



Maintenance. 

Appropriation $213,550 00 

Expenses (as analyzed below), ....... 213,544 77 



Balance reverting to treasury of Commonwealth, ... $5 23 



Analysis of Expenses 

Salaries, wages and labor: — 
General administration. 
Medical service, . 
Ward service (male), . 
Ward service (female), 
Repairs and improvements, . 
Farm, stable and grounds. 



$29,433 16 
9,063 50 
15,340 10 
22,546 58 
7,060 02 
8,951 88 



$92,395 24 



Food : — 
Butter, 
Butterine, . 
Beans, 

Bread and crackers. 
Cereals, rice, meal, etc., 
Cheese, 
Eggs, 
Flour, 

Fish 

Fruit (dried and fresh). 
Meats, 
Milk, 

Molasses and syrup. 
Sugar, 

Tea, coffee, broma and cocoa 
Vegetables, 
Sundries, 



$3,234 99 
3,155 49 
694 53 
192 76 
905 31 
678 73 
4,393 94 
5,974 40 
1,826 11 
1,610 66 
12,845 87 
24 24 
189 28 
4,322 08 
1,976 72 
526 56 
2.278 02 



44,829 69 



Amount carried forward $137,224 93 



38 



BOSTON STATE HOSPITAL. 



[Dec. 



Amount brought forward, 



Clothing and materials: — 

Boots, shoes and rubbers, .... $1,486 11 

Clothing, 3,917 02 

Dry goods for clothing and small wares, . 2,064 85 

Furnishing goods, ..... 264 86 

Hats and caps, ...... 97 82 

Leather and shoe findings, .... 33 39 

Sundries, ....... 50 



Furnishings: — 

Beds, bedding, table linen, etc $9,396 77 

Brushes, brooms, ..... 381 94 

Carpets, rugs, etc., 925 30 

Crockery, glassware, cutlery, etc., . . 1,239 86 

Furniture and upholstery, .... 2,760 25 

Kitchen furnishings, ..... 961 47 

Wooden ware, buckets, pails, etc., . . 160 71 

Sundries, 2,075 05 



\ Heat, light and power: — 

Coal, $13,761 36 

Oil 17 43 

Sundries, 470 24 



Repairs and improvements: — 

Brick, $69 01 

Cement, lime and plaster, .... 235 34 

Doors, sashes, etc., ..... 157 44 

Electrical work and supplies, . . . 676 25 

Hardware, ....... 624 94 

Lumber, 901 16 

Machinery, etc., 204 68 

Paints, oil, glass, etc., 2,142 46 

Plumbing, steam fitting and supplies, . . 2,043 25 

Roofing and materials, .... 20 87 

Sundries 503 38 



Farm, stable and grounds: — 

Blacksmith and supplies, .... $610 07 

Carriages, wagons, etc., and repairs, . . 1,211 39 

Fertilizers, vines, seeds, etc., . . . 609 68 

Hay, grain, etc., ...... 5,104 10 

Harnesses and repairs, .... 289 22 

Horses, 775 00 

Cows. 1,199 50 

Other live stock, 139 00 

Tools, farm machines, etc., .... 1,379 20 

Sundries 2,455 78 



$137,224 93 



7,864 55 



17,901 35 



14,249 03 



7,578 78 



13,772 94 



Amount carried forward, 



$198,591 58 



1910.] PUBLIC DOCUMENT — No. 84. 39 

Amount brought forward, ....... $198,591 58 

Miscellaneous: — 

Books, periodicals, etc., .... $268 78 

Chapel services and entertainments, . . 1,510 76 

Freight, expressage and transportation, . 74 23 

Gratuities, 202 12 

Hose, etc 498 71 

Medicines and hospital supplies, . . . 1,908 48 

Medical attendance, nurses, etc. (extra), . 852 48 

Manual training supplies, .... 23 82 

Postage, 233 52 

Printing and printing supplies, . . . 436 59 

Printing annual report, . . . . 137 67 

Return of runawaj^s, ..... 8 75 

Soap and laundry supplies, .... 2,067 84 

Stationery and office supplies, . . . 514 95 

Travel and expenses (officials), . . . 220 91 

Telephone and telegraph, .... 587 43 

Tobacco, 632 25 

Water, 4,315 45 

Sundries, 458 45 

14,953 19 



Total expenses for maintenance, ..... $213,544 77 

Special Appropriations. 

Balance Dec. 1, 1909, $518,974 08 

Appropriations for fiscal year, ....... 358,000 00 



Total, . $876,974 OS 

Expended during the year (see statement annexed), . . . 34,498 73 



Balance Nov. 30, 1910, . $842,475 35 

Resources and Liabilities. 
Resources. 

Cash on hand $3,908 48 

November cash vouchers (paid from advance money), 11,091 52 
Due from treasury of Commonwealth account 

November, 1910, schedule, .... 7,204 25 

$22,204 25 

Liabilities. 

Schedule of November bills, $22,204 25 



40 



BOSTON STATE HOSPITAL. 



[Dec. 



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1910.] 



PUBLIC DOCUMENT — No. 84. 



41 



LIST OF PERSONS 

Regularly employed at the Boston State Hospital. 



Superintendent (per year), 


. $3,000 


00 


Assistant superintendent (per year), .... 


. . 1,800 


00 


First assistant physician (per year), .... 


1,500 


00 


Assistant physician (per year), 


1,000 


00 


Assistant physician (per year), 


1,000 


00 


Assistant phj^sician (per year), 


900 


00 


Junior assistant physician (per year). 


600 


00 


Pathologist (per year), 


1,000 


00 


Treasurer and steward (per year), .... 


1,800 


00 


Chief engineer (per year), 


1,440 


00 


Farmer (per year), 


1,200 


00 


Assistant farmers (2) (per month) , . . . . 


$35 00 to 45 


00 


Gardener (per month), 


45 


00 


Matron (per month), 


40 


00 


Superintendent of nurses (per year), .... 


. . 800 


00 


Assistant superintendent of nurses (per month). 


45 


00 


Stenographers (4) (per month), 


$30 00 to 78 


00 


Clerk (per month) , 


50 


00 


Office attendants (2) (per month), .... 


$20 00 and 30 


00 


Telephone operators (2) (per month). 


$20 00 and 30 


00 


Seamstresses (2) (per month), 


.• . 30 


00 


Laundryman (per month), 


40 


00 


Laundry teamster (per month), 


30 


00 


Laundress (per month), 


. . 40 


00 


Laundresses (8) (per week), 


$4 00 to 5 


00 


Baker (per month), 


60 


00 


Storekeeper (per month), 


50 


00 


Supervisor (man) (per month) , 


. . 55 


00 


Supervisors (women, 4), (per month). 


35 


00 


Assistant supervisors (men, 2), (per month). 


$35 00 and 45 


00 


Attendants (men, 52), (per month), .... 


$25 00 to 40 


00 


Nurses and attendants (women, 75), (per month), . 


$20 00 to 30 


00 


Night watchmen (2) (per month), .... 


$35 00 and 50 


00 


Cooks (men, 2) (per month), 


$55 00 and 70 


00 


Cooks (women, 3) (per month), 


. . 25 


00 


. Assistant cook (man) per month) ..... 


40 


00 



42 BOSTON STATE HOSPITAL. [Dec. 

Table girls (6) (per week), $4 00 

Chambermaid (per week), 4 00 

Kitchen girl (per week), 4 00 

Painter (per week), 17 55 

Assistant painters (3) (per week), 15 00 

Carpenters (2) (per week), 17 55 

Assistant carpenters (2) (per week), 15 00 

Upholsterer (per week), 12 00 

Assistant engineers (7) (per week), 21 00 

Assistant engineer, with board and lodging (per week), . . 17 55 

Firemen (4) (per week), 17 50 

Stablemen (2) (per week), $6 90 and 10 05 

Expressman (per week), 12 40 

Herdsman (per month), 45 00 

Porters (2) (per month), 30 00 

Mason (per month), 80 00 

Teamsters (4) (per month), $28 00 and 30 00 

Farm hands (7) (per month), 30 00 

Poultryman (per month), 20 00 



1910.] 



PUBLIC DOCUMENT — No. 84. 



43 



PRODUCTS OF THE FARM AND GARDEN. 



Garden Products. 



Asparagus, 8 boxes, . $36 00 

Beans, shell, 21 bushels, 26 25 

Beans, string, 182 bushels, 136 50 

Beets, 165 bushels, 99 00 

Beets, 47 bunches, 2 35 

Beet greens, 210 bushels, 73 50 

Cabbage, 6,750 heads, 270 00 

Carrots, 164 bushels, 98 40 

Cauliflower, 50 boxes, 50 00* 

Celery, 130 boxes, 130 00 

Corn, green, 862 bushels, . • 646 50 

Cucumbers, 3 boxes, 4 50 

Dandelions, 6 bushels, 4 50 

Egg plant, 1 barrel, 2 50 

Kale, 37 bushels, 11 10 

Kohl-rabi, 15 bushels, 7 50 

Lettuce, 451 boxes, 338 25 

Mangel-wurzel, 400 bushels, 100 00 

Onions, 31 bushels, 26 35 

Parsley, 6 bushels, 3 00 

Parsnips, 108| bushels, 108 50 

Peas, 46i bushels, 46 25 

Pepper grass, 22 bunches, 44 

Peppers, 2 bushels, 1 50 

Potatoes, 3,133 bushels, 2,193 10 

Potatoes, small, 120 bushels, 18 00 

Pumpkins, 1,178 pounds, 35 34 

Radishes, 220 dozen, 55 00 

Rhubarb, 6,360 pounds, 127 20 

Spinach, 174^ bushels, 69 80 

Squash, winter, 160 barrels, 240 00 

Squash, summer, 6 barrels, 6 00 

Scullions, 3i bushels, 2 44 

Tomatoes, ripe, 758 bushels, . 568 50 

Tomatoes, green, 61^ bushels, 30 75 

Turnips, white, 256 barrels, 320 00 

Turnips, ruta-baga, 136 barrels, 170 00 



44 BOSTON STATE HOSPITAL. [Dec. 1910. 

Apples, 91 barrels, $273 00 

Currants, 629 boxes, 69 19 

Pears, 23 bushels, 40 25 

Plums, 180 boxes, 54 00 

Raspberries, 53 boxes, 10 60 

Strawberries, 2,225 boxes, 222 50 

Cherries, 26 boxes, 2 60 



Total, $6,731 16 

Farm Products. 

Ensilage, 200 tons, $1,000 00 

Fodder, green, cabbage, 22 tons, 110 00 

Fodder, green, corn, 30 tons, 150 00 

Fodder, green, clover and alfalfa, 164 tons, .... 1,148 00 

Fodder, green, millet, 30 tons, 150 00 

Fodder, green, oats, barley and peas, 58 tons, .... 290 00 

Fodder, green, rye, 25 tons, 125 00 

Hay, English, 224 tons, 4,704 00 

Hay, meadow, 26 tons, 260 00 

Rye straw, 2 tons, 48 00 

Rowen, 4 tons, 48 00 

Beef, 3,821 pounds, 267 47 

Milk, 191,409 quarts, 11,484 54 

Pork, 18,469 pounds, . 1,846 90 

Ice, 800 tons, 2,400 00 

Sale of condemned cows, hides, calves and tallow, . . . 554 19 

Sale of condemned hogs, pork trimmings, etc., . . . 334 78 



Total, $24,920 88 

Garden products, $6,731 16 

Farm products, . 24,920 88 



Total, $31,652 04 



STATISTICAL TABLES. 



[Form prescribed by State Board of Insanity.] 



35 




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48 



BOSTON STATE HOSPITAL. 



[Dec. 



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3 3 3 3 S S 3 oj!> 



1910.] PUBLIC DOCUMENT — No. 84. 49 



2. — Insane received on First and Subsequent Commitments. 





Cases committed. 


NUMBER OF COMMITMENT. 











Males. 


Females. 


Totals. 


First to this hospital, 


147 


203 


350 




10 


26 


36 






5 


6 


Fourth to this hospital , 




7 


8 


Fifth to this hospital, 




5 


5 


Sixth to this hospital, 






1 


Ninth to this hospital, 






1 


Total cases, 


161 


246 


407 




161 


244 


405 


Never before in any hospital for insane, .... 


139 


191 


330 



3. — Nativity and Parentage of Insane Persons first admitted to Any 

Hospital. 





Males 




Females. 


Totals. 


PLACE OF NATIVITY. 


Patients. 


Fathers. 


Mothers. 


Patients. 


Fathers. 


Mothers. 


Patients. 


Fathers. 


Mothers. 


Massachusetts, .... 


58 


15 


18 


64 


16 


16 


122 


31 


34 


Other New England States, . 


8 


7 


8 


14 


11 


13 


22 


18 


21 


Other states, 


8 


4 


3 


12 


10 


9 


20 


14 


12 


Total native, .... 


74 


26 


29 


90 


37 


38 


164 


63 


67 


Other countries: — 




















Armenia, 














1 






Austria, 


1 


1 




1 


1 


1 


2 


2 


1 


Canada, 


11 


11 


17 


13 


15 


19 


24 


26 


36 


England, 


4 


4 


6 


3 


5 


6 


7 


9 


12 


France, 










1 


1 




1 


1 


Germany, 


5 


10 


10 


5 


8 


7 


10 


18 


17 


Greece 










1 


1 




1 


1 


Holland, 




1 












1 




Hungary, 








1 


1 


1 


1 


1 


1 


India, 










1 


1 


1 


1 


1 


Isle of Malta 








1 






1 






Ireland, 


28 


68 


60 


54 


89 


86 


82 


157 


146 


Italy, 


4 


4 


4 


6 


9 


9 


10 


13 


13 


Norway, 




1 




1 








2 


1 


Poland, 








1 


1 


1 


1 


1 


1 


Portugal, 








1 


2 




1 


2 


1 


Roumania, ..... 


1 


1 


1 








1 


1 


1 


Russia, 


2 


2 


2 


5 


9 


9 


7 


11 


11 


Scotland, 


4 


2 


2 


2 


3 


1 


6 


5 


3 


Spain, 




1 


1 


1 


1 


1 


1 


2 


2 


Sweden 


3 


3 


3 


3 


3 


3 


6 


6 


6 


Turkey, 


1 


1 


1 


1 


1 


1 


2 


2 


2 


Wales 


1 


1 










1 


1 


1 


Total foreign, .... 


65 


111 


108 


101 


152 


150 


166 


263 


258 


Total native, .... 


74 


26 


29 


90 


37 


38 


164 


63 


67 


Unknown, ..... 




2 


2 




2 


3 




4 


5 


Totals, 


139 


139 


139 


191 


191 


191 


330 


330 


330 



50 BOSTON STATE HOSPITAL [Dec. 



4. — Residence of Insane Persons admitted from the Community. 



PLACES. 


First admitted 
TO Any Hospital. 


Other 
Admissions. 


Totals. 


Males. 


Females. 


Totals. 


Males. 


Females. 


Totals. 


Males. 


Females. 


Totals. 


Massachusetts: — 




















Suffolk County, .... 


134 


183 


317 


22 


51 


73 


156 


234 


390 


Essex County 




1 












1 


1 


Middlesex County, .... 


2 


1 










2 


1 


3 


Hampshire County, 




1 












1 


1 


Norfolk County 




1 












1 


1 


Total resident, .... 


136 


187 


323 


22 


51 


73 


158 


238 


396 


Poland, 




1 












1 


1 


Canada 


2 












2 




2 


District of Columbia, 




1 












1 


1 


England 


1 












1 




1 


New York, 










2 


2 




2 


2 


Connecticut, 




1 












1 


1 


Italy, 




1 












1 


1 


Total nonresident. 
Cities or towns 10,000 or over, 
Country districts under 10,000, 

Totals, 


3 
137 
2 


4 
189 
2 


326 
4 


22 


2 

53 


2 

75 


3 
159 
2 


6 

242 
2 


9 

401 
4 


139 


191 


330 


22 


55 


77 


164 


250 


414 



5. — Civil Condition of Insane Persons first admitted to Any Hospital. 





Males. 


Females. 


Totals. 


Unmarried, 


55 


72 


127 


Married, 


64 


75 


139 


Widowed, 


20 


42 


62 






2 


2 


Totals, 


139 


191 


330 



1910.] PUBLIC DOCUMENT — No. 84. 51 

6. — Occupation of Insane Persons first admitted to Any Hospital. 



MALES. 



Acrobat, 


1 


iVianager, 


1 
1 


Artist, .... 


1 


iviiiK dealer, 


1 

1 


Authors, 


o 
Z 


None, .... 


07 


Baker, .... 


1 


Painters, 


6 


Barbers, 


o 


Jreaaier, 


1 
1 


Bartenders, 





Physician, . . . 


1 

1 


Cabinet-maker, . 


1 
1 


Printers, 


Q 
O 


Carpenters, 


o 
O 


Salesmen, 


o 
O 


Cigar-makers, 


. . 3 


Shoemaker, 


1 


Clerks 


8 


StiPa m -fi tt.pr 


1 


Compositor, 


1 


Stenographer, 


! 1 


Draughtsman, . 


. 1 


Students, 


. 2 


Electricians, 


. 2 


Surveyor, 


. 1 


Fireman, 


. 1 


Tailor, 


. 1 


Foreman, 


. 1 


Teacher, 


. 1 


Laborers, 


. . 37 


Teamsters, . 


. . 9 


Lawyers, 


. 2 




Letter carriers, . 


. 2 




139 


Machinists, 


. . 3 







FEMALES. 



Actresses, . 


. 2 


None, .... 


. . 40 


Bookkeeper, 


. 1 


Nurses, 


. 2 


Candy-makers, . 


. 2 


Opera singer. 


. . 1 


Cigar-maker, 


1 


Saleslady, . 


. . 1 


Clerks, 


. 5 


Seamstress, 


. . 1 


Cooks, 


. 3 


Student, 


. . 1 


Domestics, 


. 14 


Tailoresses, 


. . 3 


Dressmakers, 


. 2 


Teacher, school, 


. . 1 


Factory girls. 


. 3 


Waitress, 


1 


Housework, 


. 100 






Laundresses, 


. 5 




191 


Music teachers, . 


. 2 







52 



BOSTON STATE HOSPITAL. 



[Dec. 







Totals. 


1 




C^OOCOLOCO--HrH 

rH CO CO cq 


CO 1 

LQ 

T— 1 


CO 
lO 


59.80 




AT DEATH. 


Females. 


1 




COCOCDt^T-HOCiCO 

, T-H 1— ( 1— 1 


CO 1 

CX) 


CO 

00 


61.65 


» 




Males. 


1 1 1 I iCOrHCOTiHCOC^iO 

rH rH T— 1 1— ( 


CD 


CO 


58.01 




M 

o 


Totals. 


T— 1 


1 ^ 


i-H T-i (M (M C<1 T-i 


CO 1 


CO 

to 


56.75 




PIBST ATTA 


Females. 


1 


1 ^ 


rH T— 1 T-H T— ( 


CO I 
00 


CO 

00 


59.07 




H 
<! 


Males. 


i-H 


1 1 


1 1 to Oi lO CO (M 00 ^ 


1 

CO 


o 


54.42 



I OOCOt^t^'^J^OOOOKM 
rH(MCOCOCOt^CO';^(Mi-l 



I lOOCOLOOt^t^i-HCOOSOO 
^<M(Mi-lCO(M<MrH 



I C^l^-ooir^Olr^t^lr^O^ 

1-1 (M CO i-f ^ 1-1 



O I 

CO 

CO 



05 



CO 



1— I |t— lOJi— it^OOtOi— iCit^-OO 

T-i ^ T-i CO CO CO CO CO oq 



lO I 00 (M O rH O O lO 

1— iiMCMi-iCOC^rHOq 



CO I CO l> rJH rH i-( O O CO 
i-( <M TjH T-I (M 



CO 

CO 



00 CO 
00 



^>^>^>,>,>,>^>^>^>^ 
• cc o »^ O »-0 O O O O O of • • 
^(MfMCOCO-'^iOCOt^OO 

^•^^hOOOOOOOOOo oT 

.t^o2UOO»0 0»0 0000^ -^fe 
fl i-< (M (M CO CO Tt< O CO g Og 

c3:5£ o t§ 



C3 
o 

Oi 

a 
«+-( 
o 

o 
H 



o 



1910.] 



PUBLIC DOCUMENT — No. 84. 



I I I I CO I I 



I I I I I I I <M I I 



CO I I I <N 1 



I t I I I I I I I I I 



I I I I I I I I I I CO I I I CO 



I CO T-H »H I (Ml 



r CO I CO I CO t-H -^tl 



■2 5 3 a 2 



lliliiMillill-s^^ . 



O Q 



54 BOSTON STATE HOSPITAL. [Dec. 



9. — Probable Duration of M-ental Disease before Admission. 



PREVIOUS DURATION. 


First admitted to Any 
Hospital. 




Males. 


Females. 


Totals. 


Congenital, 


6 


5 


11 


Less than 1 month, ...... 


36 


27 


63 


From 1 to 3 months, 


24 


39 


63 


3 to 6 months, 


13 


21 


34 


6 to 12 months, 


13 


29 


42 


1 to 2 years, 


10 


22 


32 


2 to 5 years 


19 


32 


51 


5 to 10 years, 


5 


10 


15 


10 to 20 years 


1 


2 


3 


Totals, 


127 


187 


314 




12 


4 


16 


Totals, 


139 


191 


330 


Average known duration (in years). 


1.11 


1.20 


1.15 



1910.] 



PUBLIC DOCUMENT 



— No 84. 



55 



c<i CO »o cc I I »-i eq I 



O to OS 1 I CO I i-H 



- 1 I 



«0»0(M I (Ml 



I^CO^ •<*<|05| ICOr-HrHMIi-H 



?3-H^ 1 I ^ 



ft > 

^5 P5 



•eiB-jox 



•S9J'BJ\[ 



rH I (M I I (M 



Is 



•saiBj\[ 



H i 

J 3 « 

n H o 
* 

-< & t> 

O O (0 



•sIB:^ox 



•siB^ox 



•s^B^jox 



I COrH,-!^. 




■ G O O fl 



56 



BOSTON STATE HOSPITAL. 



[Dec. 



Aggregates. 




05 O CO »0 t-- 1— 1 ,-( 1 ,— 1 


CO CO CO 
CO 05 (3S 
(M <M 




COC^^ US'* 1 1 1 1 rH 


o o 

■<*< 00 00 




CO ■«tl 1 CO (M ^ ^ 1 1 1 


a> CO CO 


Died. 




«5CO(N 1 «OlM 1 »-< 1 1 


S S £? 


•eaiBuiaj 


1C(M^ ICO||II|t-i|(M «o to 
I y-l 00 00 


•sai'Bjv 


1 _ _ 1 CO 1 1 1 1 


00 r-~ 

CO CO 




not 
insane. 




, , , ,,,,,,,, 1 , , , 


Discharged. 


•saiBiuaj 


III 1 1 1 1 1 1 1 1 


1 1 1 




III 1 1 1 I 1 1 1 1 


1 1 1 


not 
improved. 




CO CO I 1 1 1 1 1 I 1-H 1 


t~ CO CO 
<M CM 




COCO 1 I 1 1 1 1 1 ^ 1 


o o 

(M <M 


•6aiBj\[ 




1 CO CO 


IMPROVED. 


•si«^ox 


O ^ tH 1 1 1 1 1 1 


O CO CO 
<M lO »0 


•sa:['Buiaj 


«*«r^ 1 1 1 1 1 1 1 1 5D CO CO 
^ CO CO 


•saiBj^f 


1 CO^ 1 1 I 1 1 1 1 1 


^ in 


CAPABLE 
OF SELF- 
SUPPORT. 


•siu^oX 


(Mil rH 1 1 1 1 1 1 1 


CO 00 00 


•eaiBuiaj 


III -H 1 1 1 1 1 I 1 


1-1 (>. 


•saiBj^ 


(Mil I 1 1 1 1 1 1 1 


(M t-H ^ 


RECOVERED. 


•SIB^OX 


»o 1 1 1 1 1 ^ 1 1 1 1 


CO CO CO 

^ ^ 


•saiBuiaj 


1 1 1 1 1 1 1 1 1 1 


^3 S S 


•sa{i3j\; 


■nil 1 1 1 l-l 1 1 1 1 




Committed. 


•eiB^oX 


« 00 1 (M CO i-H T-H 1 1 


i>. »o 

o o 


•gaiBxuaj 


»0»C 1 CO.-H— 1 1 1 1 1 I 
CO T-l 


CO 

lO 

(M (M 


•sai'Bj\[ 


^eo 1 ^ .-KM r-i <M 1-1 1 1 


1 S3 S S 


FORM OF DISEASE. 


B. — Other admissions: — 

Dementia praecox, 

Dementia, organic, 

Involution psychosis: — 

Alcoholic psychoses, acute, 

Alcoholic psychoses, clironic, .... 



1910.] 



PUBLIC DOCUMENT — No. 84. 



Totals. 


•siB^ox 


00 »H 


CO 




O 05 «0 Tt< (M 1 


O CO 
OO CO 




^ 00 1 rH <-( 

o 


CO 

OS 


Died. 


•fe'IB^OX 


<M Oi <M 1 1 1 


CO CO 
O CO 


•eeiuuiaj 


00 ' ' ' 


OO 




iO i-H 1 1 1 


Oi 


Not Insane. 


•ei'B^ox 


eo 1 1 1 1 1 


eo CO 




<M 1 1 1 i 1 






^ I 1 ■ 1 1 




Not improved. 


•siB^^ox 


OS CO 1 i-H I I 


CO CO 




O CO 1 1-1 I 1 


O CO 
C<l ■ 1-1 




CO 1 1 1 1 1 


CO eo 


Improved. 


•s^B^ox 


OS Oi CO T-l ^ 1 

CO 


CO CO 
O CO 




^ CO '-I ^ 1 


<o o 

CO (M 




(M 1 I 1 1 


CO 


Capable op 
Selp-support. 


•stB^ox 


lO 1-1 1 1 1-1 .-( 


00 «5 


•saiBuia^ 


«0 rH 1 1 1 1 


t>- CO 




05 1 1 1 ,-1 ^ 


^ 05 


Recovered. 


■SIB^OX 


CO O <M 1-1 1 
CO 


CO 




^ ^ ^ ^ , 


0> 00 
(M 1-1 






rt( 05 


NUMBER OF THE 
ADMISSION. 


First admissions to any hospital, 



58 



BOSTON STATE HOSPITAL. 



[Dec. 



Q 



8 



£^ M a 

OS S 



g 43 ^ 43 

^ I .s s 

2 » a I 



s 

a 

S 
o 

'5 

I 



s" -« '5 '5 Jl; 



ft >. 73 

<U f- s „ 

ID 5 .2 « 

M 2 <; o 



1910.] 



PUBLIC DOCUMENT — No. 84. 



OS «D <M t-- 



CO I I '-H 



^ a 

2 I 

s a 

Ph S 



0) d 



60 



BOSTON STATE HOSPITAL. [Dec. 



^ 2 
55 a 



P O 



O H S 
a 05 CO 

5 o 
^ w w 

S 00 o 
O " l« 

ojQ « 
P-i 



Iz; to 

2 « 

H O 

H u 
fa 



O O 02 



-3 o ;3 



O on w 

.9 ® 2 
'o rs 

d a 

<u 

02 



.2 .2 

Ill 

!«) X « 

WHO 



1910.] 



PUBLIC DOCUMENT — No. 84. 



CO '-H ^ 



t» I eo 



CO "-I 05 



I »0 CO CO 



CO I <M 



o w o 



TO 3 



03 3 fl 
S 2 2J 



I I I 



S 

» 2 



J3 a 



fi, (X, CL, .SP w t:) 



62 



BOSTON STATE HOSPITAL. [Dec. 



1 

g 

o . 




1 1 1 1 1 1 1 1 1 1 1 1 1 It 


DIAGN( 
CATED 




1 1 1 1 1 1 1 1 1 1 1 1 1 II 


UN 




1 1 1 1 1 1 1 1 1 1 1 1 1 II 






1 1 1 1 1 1 1 1 1 1 1 1 1 II 


BECILI' 




1 1 1 1 1 1 1 1 1 1 1 1 1 II 


s 

1— ( 




1 1 1 1 1 1 1 1 1 1 1 1 1 II 


Epileptic 
Insanity. 




1 1 1 1 1 1 1 1 1 1 1 1 l-H II 




1 1 1 1 1 1 1 1 1 1 1 1 ^ II 


id 


1 1 1 1 t 1 1 1 1 1 1 1 1 II 




H 








Chroni 
Alcohoi 
Insanit 















^2 



■■5 o ^ 



•J .2 fi 



3 ."^ '•3 '-iS 



3 



00 +a 

5 -3 



W W O H^i M 

o 



1910.] 



PUBLIC DOCUMENT — No. 84. ' 



1 



2 « -2 

o w o 



.2 S 



b b b 

c3 c3 03 



O O 

s a 



-2 



2 I ^ 

o 



^' o 



Public Dociiment 



No. 84 



THIRD ANNUAL REPORT 



TRUSTEES 



Boston State Hospital 



For the Year ending Nov. 30, 1911, 




BOSTON: 

WEIGHT & POTTEE FEINTING CO., STATE PEINTEES, 
18 Post Office Squaee. 
1912. 



Public Document 



No. 84 



THIRD ANNUAL REPORT 

OF THE 

TRUSTEES 

OF THE 

Boston State HospiTAL,a- 

For the Year ending Nov. 30, 1911. 




/$vv BOSTON: 
WEIGHT & POTTEE FEINTING CO., STATE PEINTEES, 
18 Post Office Squaee. 
1912. 



50ST0i\ 



Approved by 
The State Board of Publication. 



/9II 



CONTENTS. 



PAGE 

Report of Trustees, 7 

Report of Superintendent, ....... 15 

Report of Pathologist, • . .27 

Report of Superintendent of Nurses, ..... 31 

Report of Treasurer, .34 

Statistics, ; . . 47 



TRUSTEES 



OF THE 

BOSTON STATE HOSPITAL. 



Walter Channing, M.D., Chairman, .... Brookline. 

Henry Lefavour, Secretary, Boston. 

Mrs. Henrietta S. Lowell, . . . . . . Brookline. 

Lehman Pickert, Brookline. 

Mrs. Katherine G. Devine, ...... Boston. 

Hon. Melvin S. Nash, Hanover. 

Michael J. Jordan, Dorchester. 



Stated meetings of the trustees are held at the hospital on the second 
Tuesday of each month. 



VISITING COMMITTEES, 1911-12. 



February, Mrs. Devine and Mrs. Lowell. 

March, Mr. Lefavour and Mr. Pickert. 

April, Mr. Jordan and Mr. Piper. 

May, ...... Dr. Channing and Mr. Pickert. 

June, Mrs. Devine and Mrs. Lowell. 

July, Dr. Channing and Mr. Piper. 

August, Mr. Lefavour and Mrs. Lowell. 

September, Mr. Jordan and Mr. Pickert. 

October, Mrs. Devine and Mrs. Lowell. 

November, Mr. Lefavour and Mr. Nash. 

- December, Mr. Jordan and Mr. Pickert. 

January, Dr. Channing and Mrs. Devine. 



RESIDENT OFFICERS 



OF THE 



BOSTON STATE HOSPITAL. 



Henry P. Frost, M.D., . . Superintendent. 

Samuel W. Crittenden, M.D., Assistant Superintendent. 

Stephen E. Vosburgh, M.D., . First Assistant Physician. 

Mary E. Gill. M.D., . . . Assistant Physician. 

Ermy C. Noble, M.D., . . Assistant Physician. 

John E. Overlander, M.D., . Assistant Physician. 

John I. Wiseman, M.D., . . Assistant Physician. 

Myrtelle M. Canavan, M.D., . Pathologist. 

Jane Robertson, . . . Superintendent of Nurses^ 

Jessie M. Buist, .... Assistant Superintendent of Nurses. 

Florence K Spidle, . . . Matron. 

Arthur E. Morse, . . . Chief Engineer. 

Louis S. White, . . . Farmer. 



NON-RESIDENT OFFICERS. 



William E. Elton, 
Arthur E. Morse, 
Louis S. White, . 



Chief Engineer. 
Farmer. 



Treasurer and Steward. 




Fred B. Lund, M.D., . . .J 

John Jenks Thomas, M.D., . Neurologist. 

Robert G. Loring, M.D., . . Ophthalmologist. 

Alfred M. Amadon, M.D., . Otologist. 

Harris P. Mosher, M.D., . . Laryngologist. 

Malcolm Storer, M.D., . . Gynecologist. 

Charles J. White, M.D., . . Dermatologist. 



Sl)c Olomtnontoeoltb of iHasBOcliusctta. 



TRUSTEES' REPORT. 



To His Excellency the Governor and the Honorable Council. 

The trustees of the Boston State Hospital have the honor to- 
present herewith their third annual report. 

Development of the Hospital,. 

Each year the State insane hospitals are called on to make 
additional provision for the increase in the cases of insanity 
seeking for admission. The State Board of Insanity, knowing 
the capacity of these institutions, can with some accuracy 
determine the probable number of cases which circumstances 
render it desirable to apportion to each. Situated as the Bos^ 
ton State Hospital is, in the metropolitan district, which fur- 
nishes a large percentage of the admissions to all the hospitals, 
and with a psychopathic department for the first care and obser- 
vation of acute cases, both the trustees and the Board of Insanity 
are of the opinion that this institution must be looked to, to pro- 
vide for a constantly increasing number of patients, especially of 
the more acute and excited type, who should be removed as 
short a distance as possible from their homes. 

In accordance with these views, the trustees, in their report 
for 1910, asked for a special appropriation for alterations in 
the buildings at the men's department ; a home for male nurses ; 
buildings for patients working on the farm called the " farm 
group " ; a service building, and an addition to the electric 
light and power plant. The farm group, while badly needed, 
is omitted from this year's list of requests, other demands being 
more urgent. As no special appropriation was granted the 



8 



BOSTON STATE HOSPITAL. [Dec. 



hospital last year for these purposes, the trustees would again 
respectfully submit their reasons for asking for it. In the 
report referred to, they said : — 

In visiting the buildings in the men's department, legislative commit- 
tees have very justly criticized the large amount of unnecessary space 
taken up by halls and passageways, and also the cheerlessness of them. 
Plans have been prepared for throwing some of these halls into the 
wards and taking down partition walls, in this way giving more light 
and enough extra space to accommodate about 32 patients. For . this 
purpose the trustees ask for the sum of $6,000, 

At present we have no proper quarters for male nurses, and this lack 
is one of the reasons why it is hard to retain good men in our employ. 
With the continually increasing number of patients, our present ac- 
commodations, poor as they are, are becoming overcrowded. We there- 
fore ask for an appropriation of $22,000 to provide a nurses' home for 
35 men. 

Since this paragraph was written in 1910, the plans have 
been revised so that the building, as now arranged, will provide 
for 42 men at the same expense, making a decidedly low per 
capita cost. 

For a service building for the entire institution, including a bakery 
plant, we ask an appropriation of $42,000. So far the hospital has 
had only a few small refrigerators and no storeroom of adequate size. 
Consequently provisions cannot be kept in quantity, and only a limited 
stock of general supplies. Within a comparatively short time we shall 
have a population of upwards of 1,200. The economical administration 
of an institution caring for so many patients requires a thoroughly 
equipped service building, including a refrigerating plant. 

When the infirmary buildings are completed an addition to the electric 
light and power plant will be needed. We ask $13,875 for this purpose. 

This year the amount needed will be $16,000. The differ- 
ence is explained by the fact that last year the cost of outside 
wiring to connect the infirmary buildings, if lighted from the 
present direct current plant, amounting to $2,125, was deducted, 
this being the sum allowed in . the contract for the infirmary 
buildings. As no special appropriation was granted in 1911 
and the connections have been made with the infirmary build- 
ings, the cost remains as first estimated. The reasons why this 



1911.] PUBLIC DOCUMENT — No. 84. 9 



addition is necessary are the following : It is desirable to install 
two electric current generators in the engine room at the wom- 
en's department which will enable us to do away with the elec- 
tric light and power plant at the men's department, effecting 
economy in operation. It would be a mistake to put in any 
more direct current generators, as an alternating plant will dis- 
tribute current much more economically to the scattered groups 
of buildings. 

In addition to this appropriation, we would ask for an appro- 
priation of $115,000 for a building for disturbed women and 
$34,500 for farm buildings. A real exigency exists for the 
erection of a building for disturbed women. The superintend- 
ent makes this clear in his report. In addition to what he has 
to say, we would add from our own observation, that many 
harmless patients, who need quiet surroundings are excited, 
made unhappy, and in some cases seriously injured, by the 
presence of a class of noisy, disturbed and violent patients 
who should not be treated in the same building with them. 
The number of this class is, and has been, unusually large, 
and probably will be, as the hospital of necessity must expect, 
from its ready accessibility to Boston, to receive the most dis- 
turbed class of patients. Success of treatment largely depends 
on a proper classification, which at present is impossible. If 
we can have a building for disturbed women, a much improved 
classification will result, and we shall approach still nearer the 
standard of care, which as a matter of humanity and medical 
treatment, we feel it our duty to provide. The farm buildings 
were old when the city acquired the property, and are now 
dilapidated and not worth repairing. They stand on sites 
needed for ward buildings; are inconveniently placed for ad- 
ministration, and are much too small for present needs. Their 
proximity to the hospital buildings is unpleasant and unsani- 
tary. If we are to continue to produce our own milk, as is 
desirable, both for economy and health, a sanitary dairy barn is 
an absolute necessity and one that cannot be safely ignored. 
The estimated cost is $34,500. 



10 



BOSTON STATE HOSPITAL. 



[Dec. 



Summary of Appropriations for 1912. 



Maintenance, $310,000 

For the main hospital, $270,000 

For the psychopathic department, . . . 40,000 

Building for disturbed women, 115,000 

Alterations, buildings men's department, .... 6,000 

Nurses' home, 22,000 

Service building, 42,000 

Farm buildings, 34,500 

Addition to electric light and power plant, .... 16,000 
Extension of sewage and water systems to proposed new 

buildings, 3,000 



The Legislature of 1909-10 granted an appropriation for 
the erection of an infirmary group for 300 patients, an addi- 
tion to the Butler building for the treatment of acute cases and 
a laundry and industrial building. The infirmary group will 
be ready for occupancy in the spring of 1912. The hospital 
contains a large and steadily increasing number of infirm and 
bedridden patients, and pressure on the wards will be relieved 
by placing these patients together under one roof. The laun- 
dry and industrial building was occupied during the summer. 
It is bright and attractive, and for the first time the hospital 
has adequate facilities for furnishing employment to the women. 
Further details concerning the new buildings will be found in 
the report of the superintendent. 

Psychopathic Hospital. 
The construction of the building has gone on steadily, though 
somewhat delayed by various minor difiiculties. These have, 
however, been successfully surmounted, and it is expected that 
patients will be received in the early summer of 1912. The 
external appearance of the building is attractive and makes it 
an ornament to the neighborhood. The internal arrangements, 
while not yet tested by experience, appear to be well adapted 
to their purpose. It must be remembered that this building is 
unique in character, being a general hospital for the mentally 
sick who, as far as possible, are to be treated like patients in an 
ordinary city hospital. To accomplish this purpose it is nec- 



1911.] 



PUBLIC DOCUMENT — No. 84. 



11 



essary to provide not only the facilities usually found in such 
an institution, but many added ones demanded by the special 
character of the disease. Thus we find no large wards, but 
small ones, as well as many single rooms, allowing for the 
utmost diversity of classification and treatment. Physicians' 
and head nurses' ofiices are either in the wards or close to them. 
There is an admission department, as well as one for out- 
patients and social service; examining rooms and laboratories, 
where careful tests, both mental and physical, can be made; a 
hydrotherapy plant, continuous bath rooms, solariums, roof 
gardens, and so on. 

Special attention should also be called to the fact that while 
the patients are being treated as if they were in an ordinary 
hospital, they are suffering from an illness which makes them 
irresponsible and they therefore must be carefully watched and 
protected from possible harm to themselves or others. To carry 
out the treatment which must be active, thorough-going and 
vigilant, if the best results are to be attained, there must be a 
large corps of physicians and nurses on constant duty. 

The expense of maintaining general hospitals like the Massa- 
chusetts General, and the City Hospital, is large, and the same 
will be true of the psychopathic hospital, and in considering 
the per capita cost, comparison should be made with those 
institutions and not with a State insane hospital. In the psy- 
chopathic hospital a large percentage of incipient and mild 
cases will be received. Many of these will be arrested or cured 
within a short period. 

The out-patient and social service department will treat pa- 
tients at the hospital and in their homes, often making admis- 
sion to the hospital unnecessary. This department will also 
investigate the histories of patients in their homes, and en- 
deavor to find out what may have been the causes of the attacks 
either in the patients or their environment, thereby gaining in- 
formation which may throw light on prevention. Students will 
have the advantage of studying mental disease in the wards as 
they do other diseases and when they go into practice will be 
prepared to recognize this disease in the earliest stages when 
preventive treatment is still possible. 

As a result of the work which the psychopathic hospital will 



12 



BOSTON STATE HOSPITAL. [Dec. 



inaugurate, mental disease will be better understood, and outside 
the hospital, as well as within its walls, an increasing percent- 
age of cases will be prevented or cured. The resulting eco- 
nomic saving to the State should far outweigh the high cost of 
maintenance, when it is remembered that each case of incurable 
insanity cared for in a State hospital means an expenditure of 
several thousand dollars. 

Administration. 
There has been marked improvement in this direction during 
the past year. All departments are co-operating and working 
together as a harmonious whole under the guiding hand of the 
superintendent. 

It is a source of satisfaction to go through the institution and 
find the wards, dining rooms and kitchens neat and well looked 
after. The whole staff of employees take great interest in the 
patients and perform their difficult duties willingly, cheerfully 
and loyally. The patients respond and in increasing numbers 
do their best work for the general welfare. Progress toward 
better things is everywhere apparent. 

The superintendent has given careful attention to the im- 
provement of the medical and general management of the 
hospital, and has also supervised the construction of the new 
buildings, including the psychopathic hospital. He has shown 
himself equal to all demands imposed on him, and the steady 
progress made is in large measure due to his efforts. 

Repaies and Improvements. 

Much has been accomplished toward bettering the condition 
of both buildings and grounds. Every male patient who could 
be gotten out of doors has been given such work as he has been 
able to do, and the combined efforts of all have been of great 
assistance. The State has benefited, and still more the patients 
themselves, who, if not cured, have in many instances gained 
in both mental and physical condition. 

The details of work accomplished under this heading will 
be found in the report of the superintendent. 



1911.] PUBLIC DOCUMENT — No. 84. 



13 



After Care and Social Service Department. 
The trustees desire to call attention to what the superintend- 
ent says on this subject in his report and heartily approve the 
following statement : " Eecognizing the possibilities of more 
thorough, lasting and far-reaching benefit to the patients and 
the community by thus extending the hospital's functions and 
taking an active part in the campaign for the prevention of 
insanity, I believe the time has come for the establishment of 
an after care and social service department as an integral part 
of the hospital organization.'' Extended study will be neces- 
sary to determine the best means of accomplishing this object, 
but we believe it to be of great importance. 

Death of a Member of the Board. 
On July 26, 1911, the Board sustained a severe loss in the 
'death of William Taggard Piper. At the August meeting 
of the Board, the following resolution was unanimously 
adopted : — 

The trustees of the Boston State Hospital desire to express their 
profound sense oE loss in the death of their honored associate, Mr. 
William Taggard Piper. During the whole period of his connection 
with the Board, Mr. Piper has been of unvarying devotion to its in- 
terests. He brought with him a keen appreciation of the responsibilities 
of such a trust and a very varied and valuable experience derived from 
his connection with other institutions, and this experience he placed 
generously at the disposal of the hospital and gave unstintingly of his 
time and thought. He belonged to the rare type of loyal and useful 
public servants who contribute so unselfishly to the welfare of the Com- 
monwealth. 

Appointment to the Board. 
In September, Hon. Melvin S. I^ash, of Hanover, was ap- 
pointed by the Governor to fill the unexpired part of the term 
of Mr. Piper, ending on the first Wednesday in February, 1918, 
and he assumed the duties of the position at the meeting of 
the Board on October 10. 



14 



BOSTON STATE HOSPITAL. [Dec. 



Appointment of a Medical Consulting Staff. 
At the l^oveniber meeting of the Board it was unanimously 
voted to ask the following gentlemen to serve as a consulting 
staff: — 



Chas. F. WithingtoD, M.D., 
John L. Ames, M.D., 
John Bapst Blake, M.D., 
Fred B. Lund, M.D., 
J. J. Thomas, M.D., . 
Robert G. Loring, M.D., 
Alfred M. Amadon, M.D., 
Harris P. Mosher, M.D., 
Malcolm Storer, M.D., 
Charles J. White, M.D., 



Physicians. 

Surgeons. 

Neurologist. 
Ophthalmologist. 
Otologist. 
Laryngologist. 
Gynecologist. 
Dermatologist. 



The trustees anticipate great help from the advice and co-op- 
eration of these gentlemen, in solving difficult medical prob- 
lems, and regard the hospital as fortunate in having secured 
their services. 

Full details of hospital operations for the current year will 
be found in the appended reports of the superintendent and 
treasurer. 

Respectfully submitted, 



WALTER CHAI^lSrilsTG. 
HEI^RY LEFAVOUR. 
HEI^RIETTA LOWELL. 
KATHERIE-E G. DEVI^s^E. 
MICHAEL J. JORDA^^. 
LEHMAIsT PICKERT. 
MELYIE- S. I^ASH. 



1911.] 



PUBLIC DOCUMENT — No. 84. 



15 



SUPERINTENDENT'S REPORT. 



To the Trustees of the Boston State Hospital. 

I have the privilege and duty of submitting herewith the 
third annual report of the hospital, for the year ending I^oy. 30, 
1911, together with the statistics prescribed by the State Board 
of Insanity, which are for the year ending September 30. 

There were 861 patients in the hospital at the beginning of 
the statistical year; the admissions numbered 762, the dismis- 
sals 614, deaths 140, leaving 869 at the close of the year. 

The daily average number of patients was 853.48, of whom 
732.45 were State charges, 43.27 reimbursing, and 77.76 pri- 
vate; 1,545 different patients were in the hospital during the 
year. 

There were 24 emergency, 25 voluntary, and 342 temporary 
care cases admitted. 

Exclusive of temporary care cases, transfers and returns 
from visit, 433 patients were received, of whom 380 were ad- 
mitted for the first time, 32 for the second time, and 21 for the 
third to sixth time. 

The cases never before committed to any hospital for the 
insane numbered 357. Concerning these the following facts 
are noted: 175, or 49 per cent., were foreign born, and 264, or 
74 per cent., were of foreign parentage on one or both sides. 
The average age on admission was 44.97 years; 21 per cent, 
were sixty years of age or more. 

The chief causes of insanity (excluding 119 cases, in which 
it was not ascertained) were: Excessive use of alcohol in 24 
per cent. ; senility in 20 per cent. ; syphilis in 16 per cent. ; 
worry in 10 per cent. ; arteriosclerosis in 8 per cent. 

There were among the first admissions 45 cases of general 
paralysis, 12.6 per cent, of the whole number admitted. Sev- 
enteen of the 45 paretics were women, which is an unusually 
high ratio, though not so high as in our admissions of the pre- 
vious year. 



16 



BOSTON STATE HOSPITAL. 



[Dec. 



The discharges, exclusive of transfers, and not including the 
temporary care cases, which are separately considered, num- 
bered 161. Of these, 66 were recovered, and 63 improved, — 
15 of them classed as capable of self support." The recoveries 
were 15.2 per cent, of the number committed, which is an im- 
provement over last year's record, though by no means a figure 
to afford satisfaction. It is a fact, however, that 31 per cent, 
of the admissions were hopeless cases by reason of congenital 
defect, advanced age, or organic brain disease, to say nothing 
of those recognized as suffering from psychoses usually found to 
be incurable. 

There were 145 deaths, 5 of which occurred among patients 
in temporary care.'' Excluding these and figuring on the 
committed cases only, as heretofore, the deaths were 10.7 per 
cent, of the whole number under treatment, 16.4 per cent, of 
the daily average number of patients, and 32 per cent, of the 
commitments. The cause of death was general paralysis in 
31 cases, other diseases of the nervous system in 11, pneumonia 
in 36, tuberculosis in 6. One was a suicide. 

In conformity with a practice which is rapidly extending, 
and in order that our report may be more readily comparable 
with those issued by the leading hospitals of this country, we 
have this year classified our cases under the Kraepelin diag- 
nostic headings as modified by Prof. Adolf Meyer. 

The psychopathic wards in the Butler building received from 
Oct. 1, 1910, to Sept. 30, 1911, 342 patients, 205 men and 137 
women. One hundred and six were committed to this hospital, 
139 committed or returned to other hospitals, and 101 were 
discharged without commitment, 52 of them as recovered. The 
daily average number of temporary care cases was: Men, 4.82; 
women, 3.67 ; total, 8.49. More detailed statistics of this spe- 
cial service will be found in Table la of this report. 

The variety of disorders which came under care, and the 
extent to which the opportunity to secure prompt relief in 
emergency situations was taken advantage of, augur well for 
the success of the permanent psychopathic wards soon to be 
opened in a more central and accessible location, where, with 
plenty of room for classification, and the best of equipment 
for treatment, results may be anticipated of which those here 
reported are but the promise. 



1911.] 



PUBLIC DOCUMENT — No. 84. 



17 



We have not had to contend this year with any unusual 
sickness among patients or employees, and have been relatively 
free from such diseases as tuberculosis, dysentery, and di- 
arrhoeal disorders. Segregation of the tubercular and their 
treatment in the open air during the mild season, together 
with the maximum of outdoor life for the whole population 
and scrupulous care in the handling of garbage, and the exclu- 
sion of flies, are measures which have no doubt contributed to 
this result. An effort, more or less successful, was made to 
curtail the breeding of flies, by screening and prompt removal 
of manure from the stables, and cleaning up other breeding 
places; and in general the sanitary condition of the premises 
has been improved by the substitution of granolithic pavement 
for cobblestones in the kitchen yard, laying drains, filling low 
marshy spots, etc. 

The only serious mishap I have to report is the occurrence 
of a suicide. The patient, a young man who had been in the 
hospital several months, and who was in a moody, depressed 
state, was suspected of having some harmful weapon in his pos- 
session, and while in the act of being searched by the attend- 
ants, succeeded in slashing his throat with a kitchen knife 
which he had secreted, dying in a few moments. 

Nineteen male patients eloped, all of whom, with one excep- 
tion, were returned to the hospital or else accounted for at home 
and allowed to remain there. That more do not leave without 
permission speaks well for the parole and open-door system 
which is practiced here on a large scale, more than 20 per cent, 
of the men being given parole on the grounds. Of 30 who slept 
in tents all summer with no special supervision, not one ab- 
sconded. 

Changes in the Medical Staff 
during the year were as follows : — 

Dr. John E. Overlander was appointed assistant physician 
July 1. 

Dr. Harry M. Nicholson, assistant physician, resigned Octo- 
ber 1 to accept appointment in the Massachusetts Eye and Ear 
Infirmary. 

Dr. John I. Wiseman was appointed assistant physician Octo- 
ber 1. 



18 



BOSTON STATE HOSPITAL. [Dec. 



Dr. Overlander had served two years in the Channing Sani- 
tarium, and Dr. Wiseman a corresponding period in the Kings 
Park State Hospital in 'New York, so they both entered upon 
their duties here with unusually good preparation, and are, 
from the start, valuable assistants. 

Dr. Howard A. Lane, who was engaged last year as dentist 
for the patients, resigned, to our regret, owing to other appoint- 
ments. This position is now acceptably filled by Dr. Walter 
J. Whelan of Mattapan, who visits the hospital once a week 
and devotes a forenoon to this service. 

THEi Laboratory, 
opened late in the preceding year, has had installed the addi- 
tional apparatus required, and is now well equipped for work 
in bacteriology, clinical pathology and pathological anatomy. 
Autopsies were performed on 50 cases during the year, this 
number being 35.71 per cent, of the deaths occurring in the 
hospital. Examinations of blood, cerebrospinal fluid, sputum, 
urine and f£eces were made in many cases ; bacteriological exam- 
ination of the milk was begun, and comparative tests of com- 
mercial disinfectants made in order to determine their relative 
'efficiency and cost. Close co-operation between the laboratory 
and the clinical staff is maintained through the medium of 
staff meetings, of which one each month is held in the labora- 
tory and devoted to demonstration and discussion of material 
by the pathologist. 

I have pleasure in calling your attention to the appended 
report by Dr. Canavan, showing in some detail what has been 
accomplished in her department and what is planned for the 
immediate future. 

l^uRSEs^ Training School. 
Twelve pupils comprising the class of 1911 received their 
diplomas on the evening of June 8, on which occasion appro- 
priate exercises were held in the entertainment hall, conclud- 
ing with a reception and dance. The address to the graduates 
was delivered by President Lefavour of Simmons College, and 
the diplomas were presented by Dr. Channing, chairman of 
the board of trustees. 



1911.] PUBLIC DOCUMENT — No. 84. 



19 



The report of the superintendent of nurses shows full classes, 
a large excess of applications, and few resignations among the 
pupils, all of which are evidences that the school is thriving. 
Several of the male attendants are participating in the course 
and are expected to be among the graduates next year. The 
special course of instruction for the men who do not consent to 
join the school has been continued with good results. 

Field Worker and Social Service. 

We were fortunate in securing, October 1, the services of 
Miss Kuth W. Lawton, a trained field worker from the Eu- 
genics record office conducted by Dr. Charles B. Davenport at 
Cold Spring Harbor, Long Island. The special object of this 
assignment, which is at the expense of the record office except 
for maintenance and incidentals, is the study of heredity in 
insanity, but in securing data on this subject in the homes of 
patients and among their relatives and friends, the field 
worker is able to serve the hospital, the patient and the family 
in many practical ways. Information is obtained concerning 
the family, their resources, the home conditions, — the setting 
in which the patient's disorder occurred, — and concerning the 
patient's personality, tastes, aptitudes, habits, the stresses to 
which he was exposed, etc., — the soil on which the psychosis 
developed and its exciting causes, — all of which are im- 
portant aids to the physicians in forming their judgment of 
the nature and needs of the case. Then, when it is a question 
of the patient's discharge, such a survey of the ■ situation in 
which he is placed, and a supervision by visits during the 
trial period, will constitute the most effective sort of after care. 

Recognizing the possibilities of more thorough, lasting and 
far-reaching benefit to the patients and to the community by 
thus extending the hospital's function and taking an active 
part in the campaign for the prevention of insanity, I believe 
the time has come for the establishment of an after care and 
social service department as an integral part of the hospital 
organization. It should command the interest and attention 
of all the medical officers, but should be under the special 
charge of a physician, who, with the necessary experience and 
knowledge, combined with certain essential qualifications, in- 



20 



BOSTON STATE HOSPITAL. [Dec. 



eluding convietion and enthusiasm, might devote himself (or 
herself) to this most interesting and fruitful field. The results 
would have to be meager indeed not to amply repay to the 
State the added cost of the service. 

Employment of Patients. 

The industrial rooms for both men and women have ex- 
panded into larger quarters, and a number of new industries 
have been introduced, which furnish agreeable and beneficial 
occupation for the patients of various classes, and supply many 
of the hospital necessaries at a very low cost of production. 
The men make and renovate mattresses and pillows; manu- 
facture brooms, brushes, mats, and rugs ; cane chairs, do uphol- 
stering, fit window shades, repair shoes and renovate old fur- 
niture. The women sew, do fancy work, make raffia and reed 
baskets and mats, straw hats, and rugs, repair, mark and press 
clothing, etc. The attendants and nurses are detailed to assist 
in these work rooms, and are given instruction to fit them for 
teaching and encouraging their patients in the wards to re- 
lieve and stimulate their minds by means of useful occupation. 
Experience has shown here and elsewhere that with but few 
exceptions even the dullest can be aroused to take an interest 
in something if only enough pains be taken by those in charge, 
and that the benefit to the individual is not less marked than 
the saving to the hospital in lessening of untidiness and de- 
structive tendencies. Thirty-three men and 90 women patients 
are in attendance daily in the industrial rooms. 

Outdoor work, however, for those able to participate in it, 
is held to be of even greater value than shop employment in 
promoting bodily and mental health ; and there is an unlimited 
amount of work to be done on the grounds and in the farm 
and garden; consequently, the number of outdoor workers 
among the men is larger than the shop list. The daily average 
number so engaged, excluding the winter months, was 65. 

The percentage of patients employed at all kinds of work, 
including that done in the wards, is for the men 60 per cent., 
and for the women 65 per cent. Aged and infirm patients, 
the bedridden and the violent, will account for practically all 
of the remainder. 



1911.] 



PUBLIC DOCUMENT — No. 84. 



21 



Entertainment of Patients. 
Due attention has been paid to diversions^ with the under- 
standing that these have a therapeutic value of real importance 
in many cases, besides being a recognized factor in all social 
life and a privilege of which no one, not a criminal, ought to 
be deprived if in a condition to feel appreciation. It is pleas- 
ing, and at the same time pathetic, to see how hearty is the 
average patient's enjoyment of even very simple entertain- 
ments, and to observe their cheering influence, anticipatory 
and retrospective, in the wards. The following were provided 
during the year : — 

Dance every second Monday evening from October to May. 
Dec. 9, S. di Grazia — Eccentric musical program. 

13, Mme. Helen Stuart-Richings — Recitations and impersonations. 
Feb. 6, Edward Brigham — Songs and recitations. 

13, S. Thompson Blood — Impersonations. 
Mar. 27, J. B. Giguere — • Songs and banjo playing. 

Apr. 5, Mrs. Olive W. Hilton — Vocal and instrumental concert. 
July 4, Band concert, watermelon, lemonade and peanuts. 
Oct. 13, W. E. Baker — Sleight of hand performance, women's depart- 
ment. 

28, Hospital Music Association — Concert, afternoon and evening. 
Nov. 4, W. E. Baker — Sleight of hand performance, men's depart- 
ment. 

14, Mrs. Olive W. Hilton — Vocal and instrumental concert. 
27, Avelier L. French — Bird, animal and sound imitations. 

Thirty-three men and 38 women patients attended a circus 
performance in the city on May 31 and June 1, respectively. 
August 17, there was a picnic for 45 women patients at Blue 
Hills Reservation. 

Special dinner with table and ward decorations on Thanks- 
giving and Christmas, and on the evening of the latter, Christ- 
mas trees, with distribution of presents and program of music 

In addition to the above there have been ward musicales and 
card parties, physical culture exercises, and for selected pa- 
tients basket ball and other games in the gymnasium. 



22 



BOSTON STATE HOSPITAL. 



[Dec. 



Repairs and Improvements. 
The larger items under this head were: painting Walker, 
Stedman^ Butler and A buildings outside, and all of these 
except the last inside as well, from top to bottom; erecting 6 
outside iron fire escapes, on Wards " E " and " C " and the 
employees' quarters at the women's department, and the south 
wing of the men's group ; installing new telephone exchange 
with 50 stations, connecting all departments of the hospital; 
putting new roofs on cow stable and one wing of the horse and 
carriage stable at the women's department; making rather ex- 
tensive repairs to the piggery; rebuilding a number of outside 
wooden platforms and steps; moving and rebuilding a summer 
house; making ironing boards, racks, tables, and other fittings 
for the new laundry and building laundry dry room; laying 
237 yards of granolithic pavement and walks; laying 222 feet 
of 6-inch iron pipe for new water supply to Stedman and 
Walker buildings; laying sewers, grading and roadmaking 
around the new buildings ; planting 140 trees ; clearing, drain- 
ing and putting under cultivation 9 acres of swamp land. The 
engineer's force, in addition to their regular work, laid out 
and installed shafting and pulleys for power transmission in 
the new laundry, erected and made connections to 3 motors for 
same, and made up and installed all the electric fixtures for 
this building. The engineer also superintended the overhaul- 
ing and moving of laundry machinery from the old to the new 
building. 

ITew Buildings. 
The new laundry was completed and occupied during the 
summer. Three new washing machines, an extractor and a 
tumbler dryer were installed, but the rest of the equipment is 
the old machinery moved from the former quarters, much of it 
antiquated and of little efficiency. An additional mangle is 
badly needed, also body and shirt ironers, a collar shaper and 
various pieces of minor apparatus to enable us to handle satis- 
factorily the large additional amount of work to be done in 
this department when the infirmary and psychopathic hospi- 
tal shall be occupied within the coming year. The upper floor 



1911.] 



PUBLIC DOCUMENT — No. 84. 



23 



of this building is a large, sunny, well-ventilated room, admira- 
bly suited for the purpose to which it is applied — an indus- 
trial room for women patients. 

The addition to the Butler building was occupied in October 
and completes very satisfactory provision for recent excited 
cases of both sexes, and also for the temporary care patients. 
The addition consists of an extension to each of the two Butler 
wards, in which are a dormitory, a semi-private section of three 
communicating rooms, a sitting room, and a large bathroom 
equipped with shower and tubs for prolonged baths. The 
basement contains hydrotherapeutic and massage treatment 
rooms. In these wards a complete separation is possible be- 
tween those patients who are excitable and noisy, and others 
who, removed from disturbing association with them, are 
calmer but yet too unstable to be transferred to other wards, 
and who require the special treatment for which this section is 
equipped. The new quarters are attractive and cheerful, and 
already the benefits to be expected from this important addition 
to our facilities for treating the most difficult cases are being 
experienced. 

The infirmary group is nearing completion and will be ready 
to receive patients, we hope, in January. The construction is 
first class and the arrangement, as now seen in the nearly com- 
pleted building, seems excellently suited for the care and treat- 
ment of our large quota of infirm and helpless, for which class 
it will provide quarters for 150 of each sex, including a special 
hospital ward for men and one for women. 

The Psychopathic Hospital. 
In addition to the erection, heating, lighting and plumbing 
contracts entered into last spring, and on which satisfactory 
progress has been made, the trustees have provided for a refrig- 
erating plant, elevators and hydrotherapeutic apparatus, on all 
of which work is under way. It is hoped that nothing will 
occur to prevent the building being ready for service about the 
first of June. 



24 



BOSTON STATE HOSPITAL. [Dec. 



Special Appropriations needed. 
The trustees will doubtless repeat their requests made last 
jear for additional buildings to provide for anticipated growth 
of the hospital and the consequent increase in service facilities 
necessitated by the larger number to be cared for. To these 
items there should, I think, be added a building for the dis- 
turbed and violent women patients, who at present occupy a 
building altogether unsuitable for their care and treatment, 
and located inappropriately for that purpose, contiguous to the 
wards for quiet cases, to the sleeping quarters of officers and 
nurses, and to the main hospital entrance and driveway. They 
have no privacy, but are stared at by loiterers whom their noise 
attracts, and are further excited by such attention. The un- 
avoidable sounds from these wards are the subject of numerous 
vigorous complaints from people living in the vicinity of the 
hospital. 

Maintenance Expenses. 

The amount expended for maintenance was $223,581.92, 
v^^hich, divided by the daily average number of patients, 858.12, 
makes the weekly per capita cost $4,995. Eeceipts for board 
of private patients were $19, Y50. 66; from reimbursing pa- 
tients, $7,410.81; from sales and other sources $1,463.73, 
making the total income $28,625.20. 

Deducting receipts from gross expenses, the net cost of main- 
tenance was $194,956.72, which, divided by the above average 
number of patients, gives a net weekly per capita cost of $4,357. 

The expense of maintenance for the coming year is estimated 
at $270,000 for the main hospital and $40,000 for the psycho- 
pathic hospital, or $310,000 altogether. This sum will provide 
for the considerable increase in population which will result 
from opening the new infirmary group early in the year, and 
will maintain the psychopathic hospital for six months, from 
June to December. 

Visitors. 

The hospital was officially visited and inspected by His Ex- 
cellency Governor Foss, Lieutenant-Governor Frothingham, and 
the Executive Council, with the secretaries to the Governor 



1911.] PUBLIC DOCUMENT — No. 84. 



25 



and the Council; by the legislative committee on Public Char- 
itable Institutions; Messrs. Harpham and Coe, experts for the 
Governor; the chairman, executive officer and members of the 
State Board of Insanity and their assistants and agents. Visits 
were received from many persons connected with similar insti- 
tutions or interested in them, among whom were: Prof. Adolf 
Meyer of Johns Hopkins University; Dr. William L. Russell, 
superintendent of Bloomingdale Hospital ; Dr. Robert B. Lamb, 
formerly superintendent of Matteawan State Hospital; Dr. 
Charles H. ITorth, superintendent of Dannemora State Hospi- 
tal; Dr. Donald L. Ross, superintendent of the Connecticut 
State Hospital for Epileptics; Dr. Walter E. Fernald, super- 
intendent of the Massachusetts School for Feeble-minded ; Dr. 
George L. Wallace, superintendent of the similar institution at 
Wrentham ; Dr. Arthur V. Goss, superintendent of Taunton 
State Hospital; Dr. Charles T. LaMoure, superintendent of 
Gardner State Colony; Dr. Frederick L. Hills, superintendent 
of the Eastern Maine Insane Hospital ; Dr. George H, Torney 
of the Utica State Hospital ; Dr. F. S. Meyer and M. Witlam, 
of Amsterdam, Holland, etc. 

The Assistant Physicians' Association held a meeting here 
which was attended by members of the staff from most of the 
Massachusetts hospitals for the insane; and the hospital stew- 
ards also had one of their meetings at the hospital. The classes 
from Harvard, Tufts and Boston University Medical schools 
were received for clinics, also Dr. Cabot's summer class (post- 
graduate). 

Acknowledgments. 
Thanks are returned for donations of magazines and illus- 
trated papers by the Hospital News Society, the Boston Public 
Library, Dr. Walter Channing, and Dr. Owen Copp; to Mrs. 
Guy Lowell for two framed engravings for the wards, and to 
Dr. Dixwell and members of the Hospital Music Association 
for their annual concert, which is always enjoyed. Father 
James J. McCafferty was, during the year, succeeded as Catho- 
lic chaplain by Father Edward Gallagher, to both of whom and 
to Rev. Charles S. Otto, we are grateful for faithful and com- 
forting services to patients. 



26 



BOSTON STATE HOSPITAL. 



[Dec. 



For me the year has been full of work, but free of worry, 
thanks to the cordial assistance of my fellow-workers — officers 
and employees — to whom is due and gratefully rendered most 
of the credit for such improvement in the hospital plant and its 
service as you have been pleased to note and commend. With 
renewed thanks to the trustees for their unfailing support and 
too generous treatment, 

Respectfully submitted, 



Nov. 30, 1911. 



HENEY P. FROST, 

Superintendent. 



1911.] PUBLIC DOCUMENT — No. 84. 



27 



REPORT OF THE PATHOLOGIST. 



To the Superintendent of the Boston State Hospital. 

The following is a report from the laboratory for the period 
from Oct. 7, 1910, to Sept. 30, 1911. 

Although pathological work has been done for this hospital 
since 1881 by Drs. W. W. Gannett, W. T. Councilman, F. B. 
Mallory, J. J. Thomas, E. E. Southard, E. W. Taylor, and 
R. M. Pearce, no resident pathologist had ever been appointed, 
and the necessary clinical pathology was done by the assistant 
physicians. Press of work due to enlargement of the hospital, 
more admissions, greater demands on the staff, need for meeting 
and advancing the standard of other hospitals which maintain 
laboratories, made the necessity for a definite pathological 
department obvious, and accordingly plans were maturing for 
its establishment in the minds of Drs. Copp and Frost, and the 
appointment of the writer in June, 1910, became a fact in Octo- 
ber, when the 

Oeganization of the Laboratory 
became the first consideration. Before the laboratory appara- 
tus was assembled, a problem in hygiene in the form of an 
epidemic of paratyphoid fever among the employees presented 
itself (descnption of which is to be published), and the un- 
avoidable delay of equipment proved a serious obstacle for 
assistance in diagnosis. For a time much work of interest 
was turned over to the city board of health, and the attention 
of the writer centered on clinical pathology, antityphoid inocula- 
tions and collection of epidemiological data. 

By December 1 a skillful and thoroughly trained technician 
— Miss Ellen R. Scott — was installed, from the Harvard Med- 
ical School, to whom is entrusted the details of cutting and 
staining the tissues, making stains and solutions, preparing 
media, assisting with inoculation of animals, with records and 
preparation of specimens, and taking protocol notes. 



28 BOSTON STATE HOSPITAL. [Dec. 

The regular work began in earnest in February with a mod- 
est equipment of microtomes, glassware, chemicals, sterilizers, 
incubators, centrifuges, weights and balances, for bacteriology, 
pathology, clinical pathology and histology, proportionate to 
the needs of the hospital. 

Since fan ventilation, gas and new instruments have been 
provided for the autopsy room, it is hoped that the walls will be 
repaired, and that a larger table with central drainage and over- 
head water supply can be obtained. 

Autopsies. 

Through the courtesy and persistence of the members of the 
staff, permission has been secured for autopsies in 34+ per 
cent, of the deaths, and from Oct. 7, 1910, to Sept. 30, 1911, 
50 post mortems have been performed. Protocols are made 
directly, typewritten, and a duplicate filed with the case, the 
originals being kept in the laboratory and bound into volumes. 
Protocols of the autopsies of the 190 cases in the preceding 
nineteen years are being assembled for binding. 

Teaching of ISTueses. 

Advantage of the demonstration of anatomy and the gross 
pathology has been taken by the superintendent of nurses, who 
has sent members of the training school to be in this way in- 
structed, and the staff have been in almost constant attendance 
during the performance of autopsies to correlate findings v^th 
their ante mortem diagnoses. 

Gross specimens, 35 in number, have been collected and pre- 
served in Kaiserling's fluid. It is purposed to secure suitable 
jars for displaying these specimens, which then will be avail- 
able for demonstration. Sections for histological examination 
have been preserved from each autopsy. The spinal cords are 
prepared by the Marchi and Weigert methods in each case, 
while trunk organs are examined by the nuclear and connective 
tissue stains of Mallory. Brains which show tumors, arterio- 
sclerotic or other gross lesions have been sectioned in toto, and 
are being prepared for demonstration of the degenerations in 
nuclei and tracts. Temporal bones from a series of 25 or 30 



1911.] PUBLIC DOCUMENT — No. 84. 



29 



cases have been decalcified and handed over to Dr. A. M. Ama- 
don of the Harvard Medical School for intensive histological 
study of the organ of Corti. 

Permission was received from the hospital for afternoons 
during August, that the writer might receive instruction in 
general pathology under Prof. W. T. Councilman at the Har- 
vard Medical School, and much of profit learned there will be 
included in the second course of lectures and demonstrations 
to the nurses in pathology, bacteriology and urinary analysis 
during this winter, and in the autopsy interpretations at the 
laboratory staff meetings, of which there have been 6 in the 
period covered by this report, and in which 25 autopsied cases 
have been reviewed. 

Clinical Pathology. 
Since the establishment of the laboratory, it has been ready 
to examine and report on specimens which might arise from the 
medical services, and the following is a list of work done from 
Oct. 7, 1910, to Sept. 30, 1911: — 



Pleuric fluids, 1 

Surgical specimens, 3 

Pus, 7 

Blood cultures, 8 

Bacteriological examination of stools, 10 

Bacteriological examination of urine, 10 

Vaccines, 10 

Widals, • 21 

Cerebrospinal fluids, 34 

Throat cultures, 60 

Blood counting, 121 

Urines, 407 



Total, 692 



Bacteriology. 

Prom each autopsy cultures are taken from the heart's blood 
and cerebrospinal fluid, and from glands, bladder or other foci 
when suspicion pointed to them, for completion of the observa- 
tion of the cases. Examinations of the throat for exclusion of 
the Klebs-Loeffler bacillus, stools from patients suffering from 



30 



BOSTON STATE HOSPITAL. [Dec. 



enteritis, pus from urethral and vaginal discharge, meat to 
determine effect of storage, urine from patients recovering from 
acute illness or suffering from cystitis were made, results from 
which are valuable to the physician in charge, and of interest 
to the laboratory. Many animal inoculations have been made 
to determine the presence of tubercle bacilli, and an inocula- 
tion to determine virulence of Klebs-Loeffler bacillus found in 
sputum was done. 

It is proposed to continue and extend the laboratory work 
as described in the foregoing pages, and to investigate the bacte- 
riological content of meat and milk from time to time during 
the coming months, and to complete several pieces of individual 
work for publication. 

In conclusion I wish to thank the officers who have made 
this report possible, for their interest and help, and you, who 
have given me generous encouragement. 

Respectfully submitted, 



MYRTELLE M. CAI^AYAlSr, 

Pathologist. 

Sept. 30, 1911. 



1911.1 



PUBLIC DOCUMENT — No. 84. 



31 



SUPERINTENDENT OF NURSES' REPORT. 



To tlie Superintendent of the Boston State Hospital. 

The twelfth annual report of the Training School for ISTurses 
is herewith respectfully submitted : — 



Graduating Class of 19 IL 



Edna L. Proctor. 
Annie L. Proctor. 
Helen J. Raymond. 
Grace H. Tracey. 
Sarah A. Macdonnell. 
Marion E. Stavers. 



Henrietta L. Schaffner. 
Sarah A. Goodwin. 
Maidie E. Tilley. 
Margaret A. MacLeod. 
May M. Wood. 
Annie B. Backman. 



Nursing Staff. 

Superintendent of nurses, 1 

Assistant superintendent of nurses (graduate), . . . . 1 

Supervisors, day (graduates), 3 

Supervisor, night (graduate), 1 

Head nurses (graduates), 9 

Head nurses (pupils), 8 

Night nurses (pupils), 10 

Night attendants, 5 

Bay nurses (pupils), 22 

Day attendants, 20 

Probationer, 1 

Total, 81 

Applications during the year, 324 

Applications accepted during the year, 68 

Probationers, 40 

Attendants, 25 

Former graduates of this school, 3 

Left during the year : — 

Graduates, 3 

Pupils, . . . . ■ 9 

Attendants, 28 

Probationers (one became telephone operator), .... 22 

Probationers rejected, 5 



32 BOSTON STATE HOSPITAL. [Dec. 

The training school has graduated 12 nurses during the year, 
making a total of 80 nurses since it was organized. 

Two of our graduates have resigned during the year and have 
entered a general hospital to take a postgraduate course. One 
of our former graduates returned and remained with us a few 
months in charge of the industrial room. Two other post- 
graduates also returned, and are still with us in charge of wards. 

The school opened this year with an attendance of 48 pupils, 
which is shown as follows: — 



Undergraduates, . . . . ; 8 

Seniors (including 2 men), 21 

Juniors (including 1 man), 14 

Probationers, 5 



Instruction is given by the physicians of the hospital staff, 
the superintendent of nurses, and the assistant superintendent 
of nurses, covering courses in anatomy, physiology, hygiene, 
bacteriology, histology, pathology, chemistry, hydrotherapy, 
emergencies, physiology and diseases of the skin, lungs and kid- ; 
neys, urinalysis, surgery and anaesthesia, diseases of bones, 
fractures and dislocations, immunity and serum therapy, vac- 
cines, materia medica, gynecology, obstetrics, tuberculosis, 
symptomatology, acute infectious diseases, anatomy and physi- j 
ology of the nervous system, psychiatry, massage, cooking, 
housekeeping and clinical instruction. 

Respectfully submitted. 



JAl^E EOBERTSOX, 
Superintendent of Nurses. 



1911.] PUBLIC DOCUMENT — No. 84. 



33 



VALUATION. 

Nov. 30, 1911. 



Buildings and 152 acres land taken from 



the city of Boston Dec. 1, 1908, . 


$1,000,000 


00 


79 acres land taken Nov. 3, 1909, assessed 








62,710 


00 


Amount paid on new buildings and addi- 






tions : — 








184,698 


16 




42,553 


61 


Butler, 


36,288 


35 


Psychopathic hospital (land and 






building), 


386,560 


46 


Provisions and groceries, .... 


$3,831 


66 


Clothing and clothing materials, 


8,816 


14 




50,889 


29 


Heat, light and power, .... 


1,567 


18 


Repairs and improvements : — 






Machinery and mechanical fixtures, . 


22,869 


00 


All other property, .... 


3,030 


32 


Farm, stable and gi'ounds: — 






Live stock on farm, . . . ' . 


8,316 


40 


Produce of farm on hand, . 


5,229 


30 


Carriages and agricultural implements. 


4,377 


50 


All other property, .... 


4,129 


55 


Miscellaneous, 


3,429 


11 



$1,712,810 58 



116,482 45 



$1,829,293 03 



34 



BOSTON STATE HOSPITAL. [Dec. 



TREASURER'S REPORT. 



To the Trustees of the Boston State Hospital. 

I respectfully submit the following report of the finances 
of this institution for the fiscal year ending 'Nov, 30, 1911 : — 



Balance Dec. 1, 1910, 



Cash Account. 



S3, 908 48 



Institution Receipts. 
Board of inmates: — 
Private, 

Reimbursements, insane, 

Sales : — 
Food, 

Clothing and materials. 
Furnishings, 
Heat, light and power. 
Repairs and improvements, 
Miscellaneous, 
Farm, stable and grounds: — 
Cows and calves, 
Pigs and hogs. 
Sundries, 

Miscellaneous receipts : — 

Interest on bank balances. 
Rent, 



Receipts. 



$19,750 66 
7,410 81 



$387 16 
38 08 
40 68 
23 18 
3 20 
5 03 

135 08 
475 01 
66 00 



$290 31 
16 00 



Receipts from Treasury of Commonwealth. 
Maintenance appropriations: — 

Balance of 1910, 

Advance money (amount on hand November 

30), 

Approved schedules of 1911, $203,013 92 

Less returned, . . 22 02 



$27,161 47 



1,172 42 



306 31 



$7,204 25 
15,000 00 

202,991 90 



28,641 20 



Special appropriations. 



225,196 15 
534,575 93 



Total, 



$792,321 76 



1911.] 



PUBLIC DOCUMENT — No. 84. 



35 



Payments. 

To treasury of Commonwealth, institution receipts, . $28,641 20 

Maintenance appropriations: — 

Balance November schedule, 1910, . . $11,112 73 

Eleven months' schedules, 1911, . . . 202,991 90 



November advances, ..... 9,438 10 

223,542 73 

Special appropriations : — 

Approved schedules, ...... . 534,575 93 

Balance Nov. 30, 1911: — 

In bank, $5,223 17 

In office, 338 73 

5,561 90 



Total, $792,321 76 

Maintenance. 

Appropriation $223,600 00 

Expenses (as analyzed below), ....... 223,581 92 



Balance reverting to treasury of Commonwealth, .... $18 08 



Analysis of Expenses 

Salaries, wages and labor: — 
General administration, 
Medical service. 
Ward service (male), . 
Ward service (female). 
Repairs and improvements, 
Farm, stable and grounds. 



Food: 



Butter, 
Butterine, . 
Beans, 

Bread and crackers. 

Cereals, rice, meal, etc. 

Cheese, 

Eggs, 

Flour, 

Fish, . 

Fruit (dried and fresh) 

Meats, 

Milk, 

Molasses and syrup. 
Sugar, 

Tea, coffee, broma and 

Vegetables, 

Sundries, 



$31,554 07 
12,037 10 
17,671 92 
26,157 09 
7,486 25 
9,725 16 



$5,341 02 
2,090 07 
814 65 
186 90 
970 15 
1,002 08 
4,059 22 
6,061 17 
2,226 42 
2,101 92 
14,217 46 
5 35 
189 24 
2,326 20 
2,287 36 
681 85 
2,497 80 



$104,631 59 



47,058 86 



Amount carried forward, 



$151,690 45 



36 



BOSTON STATE HOSPITAL. 



[Dec. 



Amount brought forward. 



$151,690 45 



Clothing and materials : — 
Boots, shoes and rubbers, 
Clothing, ..... 
Dry goods for clothing and small wares, 
Furnishing goods. 
Hats and caps, .... 
Leather and shoe findings, 



$1,617 60 
3,160 85 
1,178 29 
161 15 
63 33 
59 79 



6,240 91 



Furnishings: — 

Beds, bedding, table linen, etc., 

Brushes, brooms. 

Carpets, rugs, etc.. 

Crockery, glassware, cutlery, etc., 

Furniture and upholstery, 

Kitchen furnishings, 

Wooden ware, buckets, pails, etc., 

Sundries, .... 



$6,000 55 
452 79 
673 64 
1,104 04 
1,081 45 
792 08 
74 69 
1,752 81 



11.932 05 



Heat, light and power, : — 

Coal $15,337 84 

Gas, 20 00 

Oil 26 89 

Sundries, 563 83 

15,948 56 

Repairs and improvements: — 

Cement, lime and plaster, .... $226 85 

Doors, sashes, etc., ..... 119 07 

Electrical work and supplies, . . . 498 15 

Hardware 784 93 

Lumber, 1,159 33 

Machinery, etc., ...... 1,464 09 

Paints, oil, glass, etc 1,872 97 

Plumbing, steam fitting and supplies, . . 1,862 28 

Roofing and materials, .... 308 20 

Sundries, . 3,188 68 

• 11,484 55 



Farm, stable and grounds: — 
Blacksmith and supplies. 
Carriages, wagons, etc., and repairs 
Fertilizers, vines, seeds, etc. 
Hay, grain, etc., . 
Harnesses and repairs, 
Cows, 

Other live stock. 
Tools, farm machines, etc.. 
Sundries, . 



$672 08 
1,059 80 

734 29 
4,531 58 

205 12 
1,600 50 

183 45 

575 94 
1,252 27 



10,815 



Amount carried forward, ....... $208,111 55 



1911.] 



PUBLIC DOCUMENT — No. 84. 



37 



Amount brought forward, ....... $208,111 55 



Miscellaneous: — 

Books, periodicals, etc., 
Chapel services and entertainments, 
Freight, expressage and transportation, 
Funeral expenses. 

Gratuities, ..... 
Hose, etc., ..... 
Medicines and hospital supplies, , 
Medical attendance, nurses, etc. (extra) 
Manual training supplies, 
Postage, ..... 
Printing and printing supplies, 
Printing annual report, 
Return of runaways, . 
Soap and laundry supplies, . 
Stationery and office supplies. 
School books and school supplies, . 
Travel and expenses (officials), 
Telephone and telegraph, 
Tobacco, ..... 
Water, ..... 
Sundries, ..... 



$298 83 
1,719 93 
99 72 
31 45 
237 45 
75 95 
2,704 56 
925 18 
213 60 
397 30 
552 11 
193 58 
44 05 
1,029 94 
607 57 
3 83 
187 15 
592 17 
257 16 
4,692 65 
606 19 



15,470 37 



Total expenses for maintenance, ..... $223,581 92 



Specdv-L Appropriations. 

Balance Dec. 1, 1910 $842,475 35 

Appropriations for fiscal year, ....... 250,000 00 

Total $1,092,475 35 

Expended during the year (see statement annexed), . . . 539,951 06 

Balance Nov. 30, 1911, $552,524 29 



Resources and Liabilities. 

Resources. 

Cash on hand, $5,561 90 

November cash vouchers (paid from advance money) , 9,438 10 

Due from treasury of Commonwealth account 

November, 1911, schedule, .... 5,590 02 

$20,590 02 

Liabilities. 

Schedule of November bills, $20,590 02 

Per Capita. 

During the year the average number of inmates has been 858.12. 

Total cost for maintenance, $223,581.92. 
I Equal to a weekly per capita cost of $4,995. 
I Receipts from sales, $1,173.42. 
i Equal to a per capita of $0,026. 

All other institution receipts $27,467.78. 

Equal to a per capita of $0,614. 



38 



BOSTON STATE HOSPITAL. [Dec. 



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1911.] PUBLIC DOCUMENT — No. 84. 39 



PRODUCTS OF THE FARM AND GARDEN. 



Garden Products. 

Asparagus, 4 boxes, $14 00 

Beans, shell, 16 bushels, 28 35 

Beans, string-^ 721/2 bushels, 58 00 

Beets, 345 bushels, 207 00 

Beets, 100 bunches, 5 00 

Beet greens, 152 bushels, 53 70 

Cabbage, 4 tons, 100 00 

Carrots, 15 bushels, 11 25 

Cauliflower, 13% boxes, 17 00 

Celery, 67 boxes, 60 30 

Corn, green, 1,126 bushels, 1,126 00 

Cucumbers, 30y2 boxes, 22 80 

Dandelions, 741/2 bushels, 30 75 

Egg plant, 114 barrels, 3 75 

Kale, 39 bushels, 11 70 

Lettuce, 231 boxes, 115 50 

Onions, 71 bushels, 78 10 

Parsley, 8 bushels, 4 00 

Peas, 70 bushels, 140 00 

Pepper grass, 25 bunches, 50 

Peppers, 5 bushels, 3 75 

Potatoes, 1,280 bushels, 1,152 00 

Pumpkins, 1,000 pounds, 30 00 

Radishes, 421 dozen, 126 30 

Rhubarb, 9,000 pounds, 180 00 

Spinach, 25 bushels, 10 00 

Squash, winter, 182% barrels, 182 75 

Squash, summer, 15% barrels, 15 75 

Tomatoes, ripe, S8% bushels, 66 56 

Tomatoes, green, 51 bushels, 25 50 

Turnips, white, 64 barrels, 70 40 

Turnips, ruta-baga, 130 barrels, 143 00 

Apples, 721/2 barrels, 181 25 

Currants, 156 boxes, 17 16 

Pears, 45 bushels, 45 00 

Plums, 136 boxes, 40 80 



40 



BOSTON STATE HOSPITAL. [Dec. 



Raspberries, 40 boxes, $6 00 

Strawberries, 2,554 boxes, 306 48 

Blackberries, 310 boxes, 43 40 

Grapes, 180 pounds, 7 20 



Total, $4,741 00 

Farm Products. 

Ensilage, 200 tons, $800 00 

Fodder, green, cabbage, 12 tons, 60 00 

Fodder, green, corn, 5 tons, 25 00 

Fodder, green, clover and alfalfa, 199 tons, .... 1,194 00 

Fodder, green, millet, 47^/^ tons, 237 50 

Fodder, green, oats, barley and peas, 43 tons, . . . 215 00 

Fodder, green, rye, 20 tons, 100 00 

Hay, English, 130 tons, 2,730 00 

Hay, meadow, 12 tons, 252 00 

Rye, straw, 4 tons, 96 00 

Beef, 5,344 pounds, 320 64 

Milk, 184,018% quarts, 11,841 11 

Pork, 25,733 pounds, 2,315 97 

Ice, 850 tons, 2,550 00 

Sale of condemned cows, hides, calves and tallow, . . . 135 08 

Sundries, 66 00 



Total, $22,938 30 

Garden products, $4,741 00 

Farm products, 22,938 30 



Total, $27,679 30 



1911.] 



PUBLIC DOCUMENT — No. 84. 



41 



REPORT OF WORK DONE IN THE MEN'S 
INDUSTRIAL ROOMS 

For the Year ending Nov. 30, 1911. 



Articles manufactured. 




Chairs caned, various styles, 


120 


Brooms, corn, .... 


325 


Chairs scraped and varnished, . 


92 


Brooms, rattan, 


9 


Chairs upholstered, . 


9 


Brooms, whisk, 


18 


Commodes, .... 


9 


Brushes, floor polishing, Tam- 




Cushions, .... 


5 


pico, ..... 


36 


Floor brushes, handles put in, 


18 


Brushes, horse, corn, . . . 


12 


Floor poHshers, 


22 


Brushes, long handled scrub, 




Floor polishers refilled, bristles, . 


5 


Tampico, . ... 


34 


Hair, new picked (pounds). 


4,800 


Brushes, radiator, Tampico, 


2 


Hair, old, sterilized and picked 




Brushes, stove, Tampico, . 


22 


(pounds), . . . . 


10,600 


Cushions, leatherette. 


18 


Hand bag, leather, . 


1 


Mats, coir braid, 


28 


Lounge, . . . . . 


1 


Mats, coir yarn. 


16 


Massage table top upholstered, . 


1 


Mat loom, complete. 


1 


Mattresses, double, hair, . 


6 


Matresses, single, hair, 


250 


Mattresses, single, hair. 


520 


Pillows, hair, .... 


60 


Mop handles, . . . . 


19 


Rugs, hooked, .... 


9 


Pillows, hair, . . . . 


450 


Window shades, made and fitted, 


120 


Settees caned, .... 


2 






Settee, new top, 


1 


Articles renovated. 




Shades, . . . . . 


80 


Automobile seats and back. 


1 


Shoes, men's (pairs). 


403 


Boots, men's (pairs). 


60 


Shppers, men's (pairs). 


82 


Bureaus, .... 


28 


Tables 


57 


Carpets, ..... 


4 


Tents, 


4 


Carriage seats. 


4 


Tent flies 


4 


Carriage shields. 


4 


Wardrobes, . . . . 


13 


Chairs, ..... 


621 







42 



BOSTON STATE HOSPITAL. [Dec. 



REPORT OF WORK DONE IN WOMEN'S 
INDUSTRIAL AND SEWING ROOMS 

For the Year ending Nov. 30, 1911. 



Aprons, .... 


. 1,939 


Hemstitching — Concluded. 




Artificial flowers, 


. 262 


Doilies, . . . . 


3 


Bed shirts, 


48 


Table covers. 


173 


Bibs 


18 


Table napkins, 


24 


Blanket hemmed, 


1 


Hot water bag covers. 


2 


Braided straw baskets, 


2 


Iron holders, . . . . 


60 


Bread basket covers. 


2 


Jabots, . . . . . 


6 


Bureau covers, 


72 


Kimonas, . . . . 


25 


Burial sheets, . 


. 186 


Lace, crocheted (yards). 


2 


Carpet rags (pounds), 


10 


Laundry bags. 


544 


Clay models, . 


2 


Laundry bags strings. 


12 


Chemises, 


. 240 


Mattresses, . . . . 


350 


Corset covers, . 


6 


Nightdresses, . , . . 


1,030 


Doilies, .... 


11 


Overalls and jumpers. 


54 


Doilies, crocheted, 


4 


Pad covered, . . . . 


1 


Doilies, Mexican work, 


2 


Pajamas, . . . . 


12 


Drawers, 


. 384 


Petticoats, . . . . 


372 


Drawn work, pieces, 


6 


Pillows, . ■. 


300 


Dresses, .... 


. 447 


Pillow slips, . . . . 


2,520 


Dresses overcast, 


33 


Punctured brass frame, 


1 


Dress waist, 


1 


Raffia work: — 




Embroidery: — 




Bags, 


2 


Aprons, 


4 


Baskets, . . . . 


7 


Baby bibs, . 


3 


Jardinieres, . . . . 


26 


Baby pillows. 


3 


Napkin rings, 


4 


Belts, .... 


35 


Slippers, . . . . 


10 


Centerpieces, 


13 


Table mats, .... 


4 


Collars, 


12 


Wastebaskets, 


3 


Corset cover, 


1 


Workbaskets, 


1 


Doilies, 


29 


Reed work: — 




Handkerchiefs, 


4 


Baskets, . . . . 


4 


Hat, .... 


1 


Tea table 


1 


Jabots, 


8 


Wastebaskets, 


5 


Jewel bags, . 


3 


Workbasket, 


1 


Napkin rings. 


7 


Rugs, ..... 


3 


Pin cushions. 


5 


Rugs, braided. 


2 


Pin cushion tops, . 


3 


Rugs hemmed and put in frames, 


2 


Sachet bags, 


4 


Rugs, hooked, .... 


4 


Towels, 


14 


Sanitary napkins. 


302 


Face cloths, crocheted, 


6 


Screen covers, .... 


30 


Hemstitching: — 




Shades, ..... 


18 


Bureau covers. 


. 110 


Sheets, ..... 


2,870 


Commode covers, . 


12 


Shirts 


144 



1911.] PUBLIC DOCUMENT — No. 84. 



43 



Sofa pillows, 


6 


Suspenders, 


. 130 


Spread hemmed. 


1 


Tablecloths, . 


55 


Stencilling: — 




Table and stand covers. 


. 152 


Bureau scarf, 


1 


Table napkins, 


96 


Pillow cover. 


1 


Towels, .... 


. 5,605 


Sofa pillows. 


8 


Wastebaskets, fancy braid. 


2 


Table cover, 


1 


Mending. 




Straw hats. 


10 


Making bandages and nurses' 


caps. 



REPORT OF WORK DONE ON WOMEN'S 
WARDS 

Foe the Year ending Nov. 30, 1911. 



Aprons, .... 


. 1,550 


Bibs, .... 


90 


Bureau covers. 


65 


Buttonholes, 


40 


Carpet rags (pounds). 


93 


Dresses, .... 


18 


Dust cloths, 


12 


Hemstitching: — 




Bureau covers, 


56 


Doilies, 


4 


Stand covers. 


. 144 


Table covers, 


10 


Towels, 


12 


Windows curtains (pairs), 


14 


Iron holders, . ■ . 


. 133 


Jabots, crocheted edge. 


12 


Laundry bags, . 


24 


Laundry bag strings. 


24 


Nightgowns, 


41 


Nightshirts, 


6 


Petticoats, 


. 132 


Pillows made over, . 


22 


Pillow slips, 


. 2,241 


Raffia work : — 




Baskets, small, 


6 


Canoe, 


1 


Curtain loops (pairs). 


48 


Jardinieres, . 


5 



Raffia work — Concluded. 



Picture frame, ... 1 

Pin trays, .... 2 

Rowboat, .... 1 

Sandals (pairs), ... 3 

Table covers, ... 3 

Wastebaskets, ... 2 

Workbag, .... 1 

Workbaskets, ... 6 

Rugs, braided, ... 5 

Rugs, hooked, .... 3 

Rugs, rag, .... 2 

Sanitary napkins, . . . 598 
Screen covers, . . . .21 

Sheets, 3,554 

Shirts, 19 

Spreads, 36 

Suspenders, .... 202 

Tablecloths, .... 28 

Table covers, .... 283 

Table napkins, . . . 496 

Towels, 2,143 

Undershirts, .... 36 

Wrappers, .... 18 
Picking hair. 



Making bandages and sponges. 
Marking clothing, etc. 



STATISTICAL TABLES. 



[Form prescribed by State Board of Insanity.] 



Aggregates. 




to Tf< ^ «5 O M CO — <M .-H coo IM 03 «D OO IM Tti 05 


■ 


1 Tt< Q 00 <-! i-i CO c<j CO CO | co o os »c co «o »^ oo I Tt< i 

Tf Tf ooco— 1 




-ti >0 1 00 <M 00 CO 05 00 ec •>* iC <M CO CO 1 CD ^ «0 OS O CO 00 IC 00 1 
OOt^ COU5 >0 »0 CMC>1 -.tlOJ-^COi-CT-l-H kOCO ■>*< 
coco CO <-! ^ <-l CO i-H 


Temporary Care. 




Ol 1 lOCOl 1 |COS^->ti| 1 1 1 1 |COO>0<M|M-<»<t^»OI 1 1 1 
I— 1 I-H CO CO •— c -^Jf Tf< CO "5 >0 •— 1 
CM CM <M CM CM IM T-l 




CMI 1 ICMOOl 1 |00t^»^l 1 1 1 1 iooo»o-^|io>o-^eoi 1 1 1 

t-* 00 1-H 1— 1 




001 1 lOOOOl 1 lOOOCOl 1 1 1 1 ICOCMOOOII-^OICOCMI 1 1 1 

lo lom cDococo o 


Insane. 




-H CO 1 ICOlOUJCO 1 1 1 >0 00 Ttt CD CO 1 CD 00 05 CO O CO UO CM 1 
lOM< CMO IM r-( coco ^ CO CO CM T»< 05 — i 
00 00 lO C0_»0 ^ rl 


•e8{T!UI8J 


m T-l ICMt^CM-^ 1 1 |»-ICOC<lCOCO |t^l0l010»0»Hi— ICOOOOO 1-^ 1 

r- CM ■>*i T-( T-l -rtl-rtl 05000CO cm 00 cm CO 
•«*< Ttl CO CM t^CMrt 




CDiO 1-^ l-^OOCOOS 1 1 |'<*<iOC<lCOCO lOOSCO-^Ot^OO ICMOOlOOO 1 
l^t^ OlO CMCMOOCMlOCO-H lOCD-S 
CO CO CM ^ »C CM 




Patients in the hospital Sept. 30, 1910 

Viz.: regularly committed, 

emergency, 

voluntary, 

temporary care, 

Admitted within the year, 

Viz.: by regular commitment, 

emergency, 

temporary care, 

viz.: observation, 

by transfer 

from visit, .... 

Nominal admissions for discharge 

Viz.: from visit, 

from escape, 

Whole number of cases within the year 

Dismissed within the year, 

Viz.: discharged, 

as recovered, 

as capable of self-support, 

as improved, .......... 

as not improved, 

died, . . ' 

escaped, 

on visit October 1, 

Nominal dismissals for commitment, 



48 



BOSTON STATE HOSPITAL. 



[Dec. 



O5C0 I O to 00 »0 «0 lO ^ <N 50 00 »0 00 IC I 



fo M 



00 CC CO CO <M 



CO 00 ^ ! 



I .-H (M -H CO C^ O 



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iv. O ' 



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CO CO 



C<I 10 10 05 O 00 
to 10 iC »0 CO CO 



CO CO 
00 00 



o I CO 10 CO a>iM 1 



CO 10 I t— 



CO CO CO CO 



CO I ^ < 



lO r-H T-l CO '-H 



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a' 5 
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IB <H 



2 ^ 



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fiooooo - - " 
t| 2- £ 2 2 2 ' 
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lip 



2^ £ S S £ £ £ §-^-9 i 

JctejCtaiCtoiC a 3 » 

-c-5'3-5-3-5-3 Ma>-2e8 

^ ^ ^« S M S > 

000000053 's't- 

^ L< b4 U li > CO (h 0< 

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jDXi J3^^-D jo . •: 

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3 3 3 3 3 3 3 c3> 

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.fill 

.22 OT eU 

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(u > 

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fl a ^ a 

'o'Qra'o 



ilQll.] PUBLIC DOCUMENT - 


-No. 84. 


49 


la. — Temporary Care Statistics for the Year. 






Males. 


Females. 


Totals. 


Patisnts remaining Oct. 1, 1910, ...... 


Q 


o 
it 


10 


ACiniissions irom wet. i, lyiu, to. wet. i, i^ii, 


MO 


1 17 
Vol 


342 


VIZ.. cnapter ou^, iicts oi lyuy, aection o-t, .... 


A 


1 


5 


cliaptBr 504, Acts of 1909, section 43, .... 


5 


7 


12 


ciitxpttjr uu^, i'^cto ui ivWf Section .... 


11 


15 


26 




IRQ 




261 


( t/XldptUr 0»7t;, /veto Ul lUlI, ...... 


16 


22 


38 


. Whole numlDer of cases witliin tlie year, . ... 


213 


139 


352 


■nior»Vio-p(TOa frnm dot 1 1010 fji On+ 1 1011 

XJUiK/LXa/L^^ti IIWIH V_/\^t. I, ±{jL\j^ XAJ V_/v»t. i, . . . 


OOQ 


137 


346 


Viz.: recovered, ......... 


38 


14 


52 


improved, ......... 


7 


5 


12 


unimproved, ........ 


10 


4 


14 


died, .......... 




3 


5 


not insane, ......... 


6 


11 


17 


deported, ......... 


1 




1 


committed to Boston State Hospital, 


47 


59 


106 


committed to Danvers State Hospital, 


37 


8 


45 


committed to Worcester State Hospital, 


27 


17 


44 


committed to Westborough State Hospital, 


19 


12 


31 


committed to Taunton State Hospital, 


3 


2 


5 


committed to Monson State Hospital, 


2 




2 


committed to McLean Hospital, .... 


1 




1 


committed to Dr. Melius' Sanitarium, 






1 


returned to Bridgewater State Farm, 


1 




1 


returned to Medfield State Asylum, .... 


1 




1 


returned to Worcester State Hospital, 




\ 


1 


returned to Westborough State Hospital, . 


2 




2 


returned to Monson State Hospital, .... 


1 


1 


2 


returned to Worcester State Asylum, 


1 




1 


returned to Danvers State Hospital, 


2 




2 


Patients remaining Oct. 1, 1911 


4 


2 


6 


Daily average of temporary care cases, 


4.82 


3.67 


8.49 



50 BOSTON STATE HOSPITAL. [De. 



Provisional Diagnosis in Temporary Care Cases. 





Males. 


Females. 


Totals. 


Alcoholic psychoses: — 










g 


1 
1 


7 




17 


g 


OS 




2 




3 






1 


37 




A 


n 
L 


6 




2 


2 


4 


Omg And toxic psychosis i 














1 
1 






00 


51 






2 


Q 

o 




17 


12 


9Q 


iVItiiiic-dGpressi ve psychoses: 










23 


19 


40 




10 


g 


18 


Involution melHiicholisi 


3 


g 


11 




g 


g 


It 




23 


5 


28 




(J 








2 








g 
















o 
o 




















2 















2 





Delirium with heart disease, ....... 




1 


2 


Arteriosclerotic brain disease, 




1 


2 






1 


1 




2 


1 


3 






1 


1 


Not insane, 


6 


10 


16 




3 




8 


Totals, 


205 


137 


342 





1911.1 



PUBLIC DOCUMENT — No. 84. 



51 



Insane received on First and Subsequent Commitments. 



NUMBER OF COMMITMENT. 


Cases committed. 










Males. 


Females. 


Totals 


First to this hospital 

Second to this hospital, . 
Third to this hospital, 
Fourth to this hospital, . 

Fiftli to this hospital, " ' " 
Sixth to this hospital, 

Total cases. 


161 
I 
1 


219 
25 
12 
3 
1 
3 


380 
32 
13 
3 
2 
3 


170 


263 


433 


Total persons, . 


170 


262 


432 


Never before in any hospital for insane, • . . . . 


150 


207 


357 



S.~ Nativity and Parentage of Insane Persons first admitted to Any 

Hospital. 



PLACE OF NATIVITY. 



Massachusetts, 

Other New England States, 

Other States. . 



Total native, 

Other countries 
Canada, . 
Cuba, 
England, . 
France, 
Germany, 
Ireland, . 
Italy, 

Newfoundland 
Norway, . 
Roumania, 
Russia, 
Scotland, . 
South America 
Sweden, . 
Wales, 

Total foreign, 
Total native. 
Unknown , 

Totals, 



Males. 



66 
83 
1 

150 



39 



107 
39 
4 

150 



104 
42 
4 

150 



Females. 



207 



157 
41 



207 



20 



42 



156 
42 



207 



Totals. 


a 




03 








% 


"ei 




^ 






138 


39 


37 


26 


27 


31 


17 


14 


16 


181 


80 


84 


30 


26 


28 




1 




11 


16 


12 


1 


2 


1 


9 


19 


18 


93 
6 


158 


160 


3 


9 
3 


9 
3 


1 


1 


1 


12 


1 
15 


16 


2 


5 


4 


1 


1 


1 


5 


6 


5 




1 


2 


174 


264 


260 


181 


80 


84 


2 


13 


13 


357 


357 


357 



52 BOSTON STATE HOSPITAL. [Dec. 

I 



4- — Residence of Insane Persons admitted from the Communiiij. 





First .admitted 
TO Any 

H0SP1T.\L. 


Other 
Admissions. 


Totals. 






m 


m 






or) 




TO 


no 




Males 


Fema 


Total 


Males 


Fema 


Total 


Males 


Fema 


Total: 


Massachusetts: — 




















Suffolk County, .... 


149 


202 


351 


20 


55 


75 


169 


257 


426 


Middlesex County, .... 




3 


3 










3 


3 


Unknown, 


1 












1 




1 


Total resident, .... 


150 


205 


355 


20 


55 


75 


170 


260 


430 


New York, 




1 












1 




Connecticut, • 




1 












1 




Total nonresident, 




2 












2 




Cities or towns, 1C,000 or over. 


150 


207 


357 


20 


55 


75 


170 


262 


432 


Totals 


150 


207 


357 


20 


55 


75 


170 


262 


432 





6. — Civil Condition of Insane Persons first admitted to Any Hospital. 







Males. 


Females. 


Totals. 




65 


80 


145 




69 


77 


146 




16 


44 


60 






6 


6 


Totals, 


150 


207 


357 



1911.] 
6. 



PUBLIC DOCUMENT — No. 84. 

— Occupation of Insane Persons first admitted to Any Hospital. 



53 



MALES. 



Actor, . . . . . 


. 1 


Nurse, .... 


. 1 


Artist, 


. 1 


Painters, 


. . 6 


Barbers, .... 


. 2 


Paper cutter, 


. 1 


Bartender, .... 


. 1 


Peddlers, . . . 


. . 3 


Boiler maker. 


. 1 


Piano maker. 


1 


Carpenters, 


. 2 


Plumber, 


. 1 


Car starter. 


. 1 


Roofer, 


. . 1 


Chauffeur, .... 


. 1 


Salesmen, . 


. . 7 


Clerks, .... 


. 6 


Shoemakers, 


. . 2 


Druggist, .... 


. 1 


Steam fitters. 


. . 2 


Engineers, .... 


. 3 


Student, . . • . 


. . 1 


Footman, .... 


. 1 


Steward, 


. 1 


Foremen, .... 


. 2 


Surveyor, . 


. 1 


Grocers, .... 


. 2 


Tailor, 


. 1 


Insurance agents, 


. 2 


Teachers, . 


. 2 


Janitors, .... 


. 3 


Teamsters, . 


. 13 


Laborers, .... 


. 24 


Telegraph operator, . 


. 1 


Machinists, 


. 5 


Tinsmith, . 


. 1 


Meat cutter. 


. 1 


Waiter, 


. 1 


Metal polishers, . 


. 2 


Watch repairer, . 


1 


Motorman, 


. 1 






Newsboy, .... 


. 1 




150 


None, 


. 38 






FEMALES. 


Boarding house keeper, . 


1 


None, .... 


. . 62 


Book binder. 


. 1 


Nurses, 


. 2 


Bookkeeper, 


1 


Saleslady, . 


1 


Carpet designer, 


1 


Scrubwoman, 


1 


Clerks, .... 


. 4 


Seamstresses, 


. . 2 


Cooks, .... 


. 5 


Shoemakers, 


2 


Domestics, .... 


. 20 


Stenographers, . 


. . 3 


Dressmakers, 


. 3 


Teacher, school, 


1 


Housework, 


. 90 


Washerwoman, . 


. 1 


Laundresses, 


. 5 




Music teacher, . 


1 




207 



54 



BOSTON STATE HOSPITAL. 



[De 



I I I I T-H (M CO lO CO TjH 05 CO 
i-H (M (N CO <N 1-1 



I I I I 1 |»-liOCOt^i-H00 
t— I 1—1 1—1 1—1 (M 



I I I |i-iCa(MOI>l>.CX)iO 



92 1 
00 



' 

to 



■rt< (M I rH (M CO O 05 O (M 

T-i (M (M CO (M 



(N 1-1 I I T-i lO CO 00 lO CO '<:^^ 



(Ml— I I 1— IrHrHT^T— llOlOOSi— I 



CO ^ 

CO 



CO 

00 



I COiOOOOiOiOTHCqu^OiO 
T-lC^COCOCOI>COCO(Mi-l 



CO 1-1 

CO 



I T-lt^(MiOr-l^lr^OOlOC55GO 

T-li-l(M(MTtlCOi-lr-H 



I (MOOCOtOTtii-it^rtHOOC^ 



05 1—1 



Oi»0(M(MC5050COCOiOCOCO 
1— ICO(MCOCOt^OCO(M 



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1— <t-H(Nt— ("^COi— It— I 



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rH 1— I 1— I 1— I (M rH 



CO 1-1 

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o 



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p!rti-i(M(MCOCO^^COI>S O ^ O 

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1911.] 



PUBLIC DOCUMENT — No. 84. 



55 



l«0 I <M I I I I I '-H 



I I COr-i I I I I I »0(M I I 



05 I <M 1 I I I I 



»- I l-H I I I 



I I I I I I 



I I I I I I I I I I I 



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« 1--2|;2 a^-li-B >:aC-| g S S^-a S >; of o 



56 BOSTON STATE HOSPITAL. [Dec. 



9. — Probable Duration of Mental Disease before Admission. 



PREVIOUS DURATION. 


First 


ADMITTED TO AnY 

Hospital. 






Females. 


Totals. 


Congenital, 


3 


6 


9 


Less than 1 month, 


27 


26 


53 


From 1 to 3 months, ..... 


26 


40 


66 


3 to 6 months, 


24 


18 


42 


6 to 12 months, 


20 


16 


36 


1 to 2 years, 


21 


32 


53 


2 to 5 years, 


14 


38 


52 


5 to 10 years, 


3 


16 


19 


10 to 20 years, 


4 


6 


10 


Totals, 


142 


198 


340 


Unknown, 


8 


9 


17 


Totals, 


150 


207 


357 


Average known duration (in years), 


1.7 


1.54 


1.62 



1.1 



PUBLIC DOCUMENT — No. 84. 



•sit?;ox 



d I »0 00 i-Hi-l I 



o "s 00 I ^ «o eo I CO 



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58 



BOSTON STATE HOSPITAL. 



[Dec. 



TES. 




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1 C<l 


1 M 


1 O <M M ec ^ "-1 1-1 ^ 

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o 

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insan: 














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OF SELF- 
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i-H CO 


CO 

l>- 


CO 
CO 

•<*< 


<M 
CO 

•<*< 


MMIT1 










1-1 1 CO 1 (N 1 (M 1 1 

1-1 es» 


co 

«5 


CO 
CO 


CO 


O 

O 






1 <M 




1 1 ^t^i-lrt(N 1 (M 1 


o 


o 


o 



'■Hi 



. m 



.2 fl 
"o 2 

j3 a3 03 5 'ft tn-- 

oil- ftoTaj § 

g-2 g-? Si 



1911.] 



PUBLIC DOCUMENT — No. 84. 



59 



Totals. 


•siB^ox 


lO 00 •<»< «o t>- 

(M 


T-H «0 

C CO 
CO CM 




>0 »0 CO CO 1 


CO >n 
05 ■<s< 


•S81TJJ\[ 


O CO T-H (M 1 <M 

O 


oo — < 

o o 


Died. 


•s^^ox 


00 00 ^ ^ 

(M 


O <3i 




OO i-H r-< 1 


00 CO 
00 t-- 


•69It5K 


O ' ' ' ' 


IC 


Not insane. 


•SIB^OX 


CO 1 1 1 1 1 


CO CO 




CO 1 1 1 1 1 


CO CO 


• 631^1^ 


1 1 1 1 1 1 




Not improved. 


•s^^ox 










<M 1-1 




0C> 1 1 1 1 1 


oo 


Improved. 


•ei^^ox 


CO O (M >-c (M 1 


00 ^ 
CO 




O (M 1 (M 1 


<— 1 lO 
CM 




O 1 1 ,-1 I 1 


o 


Capable op 
Self-support. 


•siB^ox 


05 CO tH tH I 1 J2 

1 




CO (M 1 1 1 1 






CO 1-1 T-< 1 1-1 


o lo 


Recovered. 


■s^Bc^ox 


in CO 1 (M CO 1 


O (M 
CO UO 




<C> 1 C<J CO 1 


CO <M 




03 <M 1 1 1 1 


1-C 

CO C-i 


NUMBER OF THE 
ADMISSION. 


First, 

Second , 

Third 

Fourth, 

Fifth, 

Sixth 

Totals 

First admissions to any Kospital, 



60 



BOSTON STATE HOSPITAL. 



[Dec. 



O m 
D O 
(6 » 



H o 12; 



<6i 

« S 
ca w o 
a H « 



J in 



Pi 



CO ^ 



»-l C<» l-H 



5^ 



OS a 
o H 

<3C 



I I I 



I i 



6 5 w oi 



I 

1 a 



.2* .y .a 3 2 



o ^ 

a o 



o o w w 



B a 



.2 

s 

>; a 

oa o 



1911. 



PUBLIC DOCUMENT — No. 84. 



61 



«-i eo — I 



CO tH 



<N ^ 



rH i-H 



CO I y-i 



i 2 



=° .2 £ 

1 i « 

^ .a >. 

I Ef a 

o o § 



= 1 1 i 



O 



o w ^ 



62 



BOSTON STATE HOSPITAL. 



[Dec. 



«(2 



g ^ d 
5 w a 

MM 



3 ^ 
o o 

< s 

« Q 
Ph O 

o 



> W 

lag 



w H CO 
HMO 
U C3 B 

H <; O 



S « .2 
.-^ .2 



S «R 8j « 
o "m "43 



Z -2 



5 g 



1911.] 



1 1 1 . 1 ^ , , , 1 , . . .11111 




> 1 1 1 1 - 1 1 1 . 1 1 1 




' '1 


- 


1 1 1 > • • - 




' ' ' - ' ... 1 . , , . 


- 


.1111 .III , , ^ , II,,,, 




. . 1 , , ^ , , , , , , , , , ^ , , , 




... 1 1 1 .1 , , ^ , , , 




. , , , 1 ^ , , , , , , , .11,1, 


<M 


' 


o 


.I.-H^ .-I'-I.CO tl,,,l 


o 


(III, III, 1 , , , , 1 , , 1 1 


• 


, . , , , , - . , , , . . , . , , , 1 










■ 






— ,,,, 1,1.11 








ll.l, ,,,, 


CO 


1,.,,^, 


CO 


.1.1, , , . 1 , , , 1 .11,11 




T-I||(M l.(MIII 


- 


lllll ^,,rH l^ll ,|C<1,I, 






Arteriosclerosis and broncho-pneumonia, 

Organic heart disease and interstitial nephritis. 
Respiratory system : — 
Broncho-pneumonia, 

Pulmonary tuberculosis, 

Digestive system : — 

(Esophageal ulcer, 

Genito-urinary system ; — 
Cystitis 

Nephritis chronic interstitial 

Toxic delirium (morphia) and broncho-pneumonia, . 

Totals 



BOSTON'^STATE HOSPITAL. 



[Dec. 





<; 

^^'^ 




1 


T-H 


1 




CO 


CO 


1 




27.63 


z 

O 


WHOLE KNC 
PERIOD OF HO 
RESIDENC: 




1 


1 


1 


to 


CO 


(M 


1 


o 

T-H 


14.63 


Admissi 




1 


T-H 


1 


(M 


1 


1-H 


1 




CO 

1-H 


Other 






1 


rH 


1 


CO 




<M 


1-H 


1-H 


40.45 


All 


WHOLE KNC 
PERIOD OF M] 
DISEASE. 




1 


1 


1 






(M 


1 


O 


15.70 






1 


1-H 


1 




1 


1 


T-H 




24.75 




TION. 




T— 1 


1-H 


(N 

1-H 


o 

T— 1 




(M 


1-H 


to 


18.25 




E DURA 




1 


LO 




CO 


to 


T-H 


1-H 


to 


9.81 


a 

< 

Eh 


WHOL 




rH 




to 




1> 


T-H 


1 


1^ 


8.44 


s 


DENCE. 






to 






CO 




1 


(M 

to 


12.03 


SD TO A 


AL RESU 




1 


1-H 


00 




1 


1-H 


1 


to 


5.85 


Eh 
Q 


Eh 

05 
O 

a 




(M 


CO 


CO 


CO 


•CO 


1 


1 




6.18 


First 


IFORE 
ST. 




00 
1—1 


to 

1-H 


05 


to 




1—i 


1 


to 


6.26 




TION BE 
DMISSIOl 




CO 


C5 


CO 


CO 


CO 




1 


to 


3.96 




Q 




(M 

T-H 


CO 


CO 


(M 


1-H 


1 


1 




CO 



months 


months 


months 


years, 


years. 


CO 


o 






to 


o 


o 

-(-= 


o 

-♦-> 


O 


o 


1-H 


CO 


CO 


T-H 





02 
f-i 

a 
<v 
>> 
to 

> 

o 



1911.] PUBLIC DOCUMENT — No. 84. 



1 |rH,-H(MT-lCOt-l(M(M 


O LO rH ^ 

CO 


1 1 rH 1 rH 7— 1 lO rH 1— 1 1 


o »o ^ E2 

T-H 1—1, 

CO 


1 1 1 r-^ T-H 1 T-H 1 T-t (N 


CO 1 O 

LO 

1— ( 


,-1 1 1 1 IrHlOCOCOCO OiOi— 1 


1— t 1 1 1 1 T-H CO CO 1 


O lO o § 

CO 


1 1 1 1 1 1 (N T— 1 1 CO 


CO 1 CO 

to 


(MC01>»00OOrH C0C0 1 
i-H Cq TjH T-l 


107 
12 
119 
39.92 


T-HrHiOCO»OCOQ005C^ 1 


CO CO £5 

CO 1> 

CO 
CO 


T— l(M(M»OiOI>.COrtii— 1 1 

T— 1 


O CO CO 


liOCOCOi-HOOrH-^i-i 1 

(M (M i-H (M 1-1 rH 


119 

119 
14.92 


1 05 lO 1-1 00 <M 1 1 

T— ( T— 1 rH 1— 1 


CO CO ^ 


T— 1 


1—1 


(^q^t^^coooscoci 1 


107 
12 
119 
19.56 


i-ii01>COC50(MiO(M 1 
1-1 <M 


CO CO P 
CO l> 

(M 


i-iOOiOTticot>.,-H 1 1 

rH 


O CO CO CO 


B. — Died: — 

Congenital, .... 

Under 1 month. 

From 1 to 3 months, . 

3 to 6 months, . 

6 to 12 months, . 

1 to 2 years, 

2 to 5 years, 
5 to 10 vears 

10 to 20 years, 
Over 20 years, 

Totals, 

Unknown, .... 

Totals, 

Average of known cases (in months),